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Dilemmas of Ambulance Professionals in Attending an Emergency within Eight Minutes: The Ethics of Target Setting

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“What you measure is what you get” (Kaplan and Norton, 1992: 71). This adage highlights the importance of measuring the right things. The choice of the indicators has a major impact on the operation and direction of the organization and the knowledge of the factors which drive behaviour and influence performance in an organization for achieving accountability and results (Larbi-Apau et al., 2010: 7; Henri, 2008). As the use of performance indicators has become widespread in the UK public sector, the academic writing has tended to focus on the implications and consequences and on the technical qualities of the indicators and the cost of implementation and operation on the other hand by the practitioners (Bird et al., 2005). It is agued that much less has been discussed publicly about the application of the indicators and their effects, or what has been learned by the managers and officials about devising, implementing and using them (De Bruijn, 2007).

Discussions on performance have included views being expressed on different aspects of performance within the wider public sector (Light, 1997); between top-down, bottom-up or balanced approaches to performance measurement (OECD, 1994; OECD, 1997); about quality and performance (Morgan and Murgatroyd, 1994); and accountability and performance (Hillisan et al.,1995; Day and Klein, 1987; Power, 1994). Additionally, models for measuring performance and quality are discussed in the literature (George, 1992; European Foundation for Quality Management, 1996; Kaplan and Norton, 1992; Kaplan and Norton 1996; Talbot, 1998; Talbot 1999). The argument against performance measurement centres around the complexities of running public services (Talbot, 2005); transaction-costs (Hood et al.1999); manipulation and deception (Bevan and Hood, 2004); unintended consequences (Smith, 1990; Smith, 1995); and the performance paradox (Van Thiel and Leeuw, 2002; Meyer and Gupta, 1994). Notwithstanding the literature on performance measurement and its management, the “puzzle of performance” remains unsolved and performance measurement still remains a popular subject of inquiry.
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Document Type: Research Article

Publication date: 01 January 2011

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