Measuring Performance: A New System for the National Health Service

Abstract

On 22nd September 1983 the Department of Health and Social Security issued the first national package of ‘performance indicators’ to the 14 Regional Health Authorities (RHAs) and 192 District Health Authorities (DHAs) which make up the National Health Service in England. Introducing this central government initiative, the junior minister said that it gave ‘local managers, for the first time, the facility to compare local performance with what is happening elsewhere in the NHS’ (Department of Health and Social Security 1983). The DHSS also set up a DHSS/NHS Joint Working Party on Performance Indicators, which at the time of writing has still to produce its recommendations for developing the present indicator set. After only one year’s experience of the new system, any judgements must of necessity be tentative. This paper is based on correspondence with more than 100 of the 207 Regional and District Health Authorities (hereafter RHAs and DHAs), supplemented by a literature search and a dozen lengthy interviews with District Administrators and other officials with significant roles in the 1983 initiative.

Performance Regimes in Health Care: Institutions, Critical Junctures and the Logic of Escalation in England and the Netherlands

“…Although there had been some official concerns with NHS hospital efficiency (measured as patient 'throughput' in relation to beds) in the early 1950s (Cutler, 2007), and we found some evidence of regionally based indicator development in Oxford and the West Midlands in the late 1970s, the first quantitative NHS performance regime that can be seen as both relatively comprehensive and relatively durable was 'invented' in 1982, coming into operation in the NHS in 1983 in the form of a package of 70 PIs, mainly derived opportunistically from existing administrative datasets, and very much weighted towards measuring inputs and efficiency (Pollitt, 1985). The Conservative government elected in 1979 had inflation control as a major economic objective, with public expenditure reduction as one means to this end, but was also under a number of political pressures in relation to the NHS, including sustained lobbying from the Confederation of British Industry concerning the substantial growth of the NHS workforce at a time when its workload appeared to be static (Harrison, 1994: 33-4).…”

Managerial Responses to Externally Imposed Performance Measurement in the NHS: An Institutional Theory Perspective

“…Due to the limitations of financial performance measurement (PM) adopted in the public sector (Hopwood, 1984;andPollitt, 1985 and1986), some have suggested the use of a multi-dimensional approach for delivering organisational long-term objectives and fulfilling key stakeholders' interests (Jackson, 1993;Van Peursem et al, 1995;Atkinson and McCrindell, 1997;Ittner and Larcker, 1998;and Kaplan and Norton, 2001). Indeed, several studies have demonstrated how multi-dimensional PM can be used for internal control in various public sector organisations (Ballantine et al, 1998;Chow et al, 1998;Kloot and Martin, 2000;and Aidemark, 2001).…”

Public-private boundaries and the transformation of the NHS

“…Davies' (1987) advice that we drop the notion of privatization in favour of an analysis of how commercial principles and market mechanisms challenge traditional thinking about state welfare provision presumes a false dichotomy. The 'new managerialism' emphasizes performance, achievement of objectives and innovation (Pollitt, 1985;Kelly, 1991) and it plays a direct role in the shifting of the public-private boundaries. This emphasis upon objectives and performance, interacting with the framework of legal possibilities, the government's ideological orientation towards the mixed economy of health-care and severe financial constraints, pushes managers in the direction of choosing methods which often entail the revalorization of labour (for instance, expulsion of 'bed-blockers', contracting out, income generation schemes, etc.).…”