PERFORMANCE MEASUREMENT OF NHS HOSPITAL

NHS hospital in terms of performance measurement

NHS hospital in terms of performance measurement

Introduction

There are many reasons for measuring performance. The ultimate goal is to ensure that the hospital delivers good quality care, and the most important aspect of 'quality care' is whether medical interventions improve patient outcomes, in terms of the length and quality of their lives. The way in which most healthcare systems approach this issue is to measure and manage processes of care and activity. Process quality performance focuses on whether doctors and nurses are polite to patients and whether hospital food is edible, car parking is adequate and how the institution fares in terms of patient and staff satisfaction surveys.

“Performance” must be defined in relation to explicit goals reflecting the values of various stakeholders (such as patients, professions, insurers, regulators). In reality, however, very few performance measurement systems focus on health outcomes valued by customers. “Measurement” implies objective assessment but does not itself include judgement of values or quality; these may be added by those who later present and interpret the data. At the system level, improvement in such areas as health priority setting, system planning, financing and resource allocation, professional recognition and overall quality management often become important aims of health reforms. At the national level, many countries, such as Ireland (1), Denmark (2), the United Kingdom (3), and the Germany (4), have developed frameworks for performance assessment and improvement. At the European level much work has been done to summarize data on hospital performance and quality assurance policies in the European Union (5), accession states (6) and other WHO Member States. General recommendations on the development and implementation of quality improvement systems in health care were made to health ministers by the Council of Europe in 1997 (7), and best practices in the efficient and effective delivery of services were published by the European Commission in 1999 (8).

At the global level, findings concerning health systems performance measurement in 192 Member States were summarized in the WHO World Health Report 2000 (9). This document sets out a framework for evaluating and improving performance of health systems in four key functions: providing services, creating resources, financing and oversight.

Hospital performance may be defined according to the achievement of specified targets, either clinical or administrative (10). Ultimately, the goal of health care is better health, but there are many intermediate measures of both process and outcome. Targets may relate to traditional hospital functions, such as diagnosis, treatment, care and rehabilitation as well as to teaching and research. However, both the definition and the functions of hospitals are changing, as emphasis shifts from inpatient care to ambulatory care, community outreach programmes and health care networks (11). Hospital performance may thus be expected to include elements of community care and public health, as well as social and employment functions. These dimensions of hospital performance have been analysed in the European context (12).

Measurement is central to the concept of quality improvement; it provides a ...