Performance measurement for health system improvement: experiences, challenges and prospects, WHO/Europe 2008

The key messages of this document are:

• Performance measurement offers policy-makers a major opportunity for securing health system improvement and accountability.
• Performance measurement aims to improve the quality of decisions made by all actors within the health system.
• Securing improved performance measurement often requires the active leadership of government.
• Major improvements are still needed in data collection, analytical methodologies, policy development and implementation of health system performance measurement.
• Definitions of performance indicators should be clear, consistent and fit into a clear conceptual framework.
• Policy-makers should pay particular attention to the political and organizational context within which performance data are collected and disseminated.
• Considerable progress has been made in developing performance indicators for acute hospital care, primary care and population health, but for mental health, financial protection and health system responsiveness research is at a much earlier stage of development.
• The development of individual performance indicators requires concerted expert and political attention, and these indicators should: aim to provide information that is relevant to the needs of specific actors; attempt to measure performance that is directly attributable to an organization or actor; aim to be statistically sound, easy to interpret and unambiguous; and be presented with full acknowledgement of any data limitations.
• The presentation of performance measurement data and how this influences its interpretation by patients, providers and practitioners and the public require more attention.
• Public reporting has many benefits, but can lead to adverse outcomes; mechanisms should be put in place to monitor and counteract these adverse outcomes.
• An important use of performance measurement is to provide feedback to clinical practitioners on their actions and how these compare to those of their peers.
• Performance measurement systems should be monitored frequently to ensure alignment with other health system mechanisms and to identify areas for improvement.
• Experiments under way to examine how performance measurement can be used in conjunction with explicit financial incentives to reward provider performance are a promising area for policy and a priority for further research.
• A better evidence base on which to underpin performance measurement policy is needed, and new initiatives should be subject to rigorous evaluation.