Modern measurement for a modern health service.

Abstract

The use of performance measures that enable aspects of health care delivered in different institutions to be compared are fraught with difficulties. However, despite inherent international concerns—about validity, comparability, and usefulness—they are here to stay. The challenge for all health systems is to find ways of using performance measures to promote real improvements in care. Questions such as whether public disclosure of comparative performance measures should be used to make external judgements—for example, in the form of league tables—or whether are they better used as tools for internal reflection to support quality improvement are the focus of active international debate. Changes in the use of performance data in any system have implications for others.1 The new approach to be implemented in the UK will therefore be watched with interest. The recently published 10 year plan for the NHS2 contained an initiative that has profound implications for both performance management and quality of care. The NHS performance assessment framework (PAF)3 already makes comparative indicator data publicly available, including clinical indicators such as readmission rates and perioperative mortality rates. The annual publication of these performance indicators4 by the NHS is about to be supplemented by a new “traffic light” …