This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Bevan, G. Search for Related Content Social Bookmarking                         What's this?

Setting Targets for Health Care Performance

Lessons from a Case Study of the English NHS

London School of Economics and Political Science, UK

This paper examines problems of setting targets for health care performance in which the centre sets a uniform set of targets and levels of performance. The case study examined by the paper is from the system of performance assessment of 'star ratings' that was introduced from 2001 by the Department of Health to give each organisation in the NHS in England a single summary score from zero rating to three stars. Star ratings were directed at holding trusts' chief executives to account for the local delivery of national priorities through a process of 'naming and shaming', in which Chief Executives of zero-rated organisations were at risk of losing their jobs. This paper outlines the underlying model and its three underlying assumptions: the centre can determine a scoring system to prioritise what matters; failures of performance that are not reflected in the scoring system do not matter; and the advantages of a system of scoring on accountable targets outweigh the disadvantages of various types of gaming responses. This paper examines the application of the model of star ratings to a case study of Primary Care Trusts (PCTs), which are complex organisations with three diverse sets of responsibilities: delivering primary care, commissioning secondary care, and supervising public health. It outlines an alternative model and the issues this raises for governance of health care performance.

Key Words: Performance assessment; Targets; National Health Service; Regulation

National Institute Economic Review, Vol. 197, No. 1, 67-79 (2006)
DOI: 10.1177/0027950106070036


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				G. Bevan Have targets done more harm than good in the English NHS? No BMJ, January 16, 2009; 338(jan16_2): a3129 - a3129. [Full Text]

				L. Webb and T. Ryan Hitting the Target and Missing the Point: Is the United Nations Playing Games with the World's most Vulnerable? Journal of Health Management, January 1, 2009; 11(1): 229 - 241. [Abstract] [PDF]

				R. Hamblin Regulation, measurements and incentives. The experience in the US and UK: does context matter? Perspectives in Public Health, November 1, 2008; 128(6): 291 - 298. [Abstract] [PDF]