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Measuring Up Improving Health System Performance in OECD Countries: Improving value for money in the United Kingdom National Health Service: Performance measurement and improvement in a centralised system

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This paper charts the development of performance measures in health care in England and their current use in managing the NHS. The last 10 years have seen a shift from measures of activities and costs, to measures of outputs and outcomes and from a focus on efficiency to a "balanced scorecard" approach to monitoring and measuring performance. It has also been recognised that performance measures are only one element of a performance management system. The current framework for assessing NHS performance, "The Performance Assessment Framework (PAF)" is complemented by mechanisms for defining standards and targets (the NHS Plan, National Service Frameworks and National Institute for Clinical Excellence), by systems of incentives (including NHS Performance Ratings, a system of "earned autonomy" and a new NHS Performance Fund), and by services to monitor and support behavioural change (clinical governance, a Commission for Health Improvement and a Modernisation Agency). The paper reflects on what has been learnt from the NHS's experience with performance measurement and performance improvement to date. It ends with some thoughts about future developments.

Document Type: Review Article

Publication date: 2002-04-01

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