Instead of telling a manager to maximise something, it is more usual to set a standard or goal. A manager is set a target and his performance is judged by his success in achieving or bettering this figure. This figure is a performance indicator and is used to show how successful managers and organisations are performing. For this figure to be of any use it needs to be comparable to a budget of some sort or a competitor’s figure. This is so that organisations have something to benchmark their performance against and so that they can analyse their performance against their competition.
A performance indicator can be seen to be any target or goal that can be used to judge whether an organisation is successfully performing in its market. However, performance indicators are just one tool in the arsenal of efforts to improve quality, management, and accountability. They are not a substitute for quality assurance, management audit, or contract monitoring activities. In fact, how these activities are used and embedded in these activities and how they relate to and support these activities must also be properly specified and understood to develop a useful performance indicator system.
- The reasons that people want organisations to produce performance indicators vary depending on the involvement and interest that they have in the organisation. This is because there are various stakeholders of any organisation such as directors, managers, consumers, policy-makers, providers and purchasers who all have different expectations. These different values and expectations result in different choices of performance indicators and varying importance’s being given to these indicators. This means that the values and expectations of stakeholders in an organisation shape the character of the performance measurement system. They also shape the goals and objectives of an organisation that, in turn, determines the selection and ranking of performance indicators and the criteria by which performance is judged to be adequate.
Managers when concerned with performance indicators are often looking for help to identify scope for improvement and to then to share this knowledge so that they can implement a best practise approach to business. Managers also use performance indicators to benchmark performance as well as using indicators to analyse competitors in order to obtain a clearer picture as to their position in the market. Managers also want performance indicators so that for quality management and improvement purposes as well as marketing. Managers trying to reach key targets may also use indicators to see if they are reaching these. Managers also want indicators so that they can focus on the performance on a particular division of an organisation and to help to make purchasing decisions.
Performance indicators are used by parliament to monitor accountability. The UK Government also uses performance indicators to help with policy-making, purchasing decisions and budget formulation. Performance indicators are also used by governmental agencies when controlling nationalised industries and to help in the regulation of other industries. The UK government, for example, uses indicators regularly in its monitoring of the NHS.
Consumers need information on performance to make various decisions when dealing with different organisations. They therefore want performance indicators to be produced to help them make purchasing decisions, choose providers and to check certain firms are accountable. Consumers also want indicators to track quality and responsiveness of the different systems of care available to them. Other people that want performance indicators produced include shareholders who can use the information to make informed decisions when buying and selling shares. Accreditation agencies are also starting to use indicators to monitor adherence to regulations and standards and to guide accreditation and program review decisions.
There are many different reasons for various people to want organisations to produce performance indicators. However, performance indicators are all aimed at efforts to improve three broad areas these are quality, management and accountability.
- Physician’s performance is increasingly being profiled in the United States in order to
release performance data to the public and make routinely collected data available to healthcare purchasers and regulators. The UK is soon likely to follow suit with this large use of performance indicators in the health sector. These indicators are being used in an attempt to measure the performances of doctors and providers of healthcare by supplying interested parties with information on the structure, process and outcomes of healthcare. The idea of using performance indicators for general practise (GP) is that analysing patterns of care will help to reduce the variation in performance between doctors and lead to improvements in the quality of healthcare. This involves using the indicators to help identify scope for improvement and then this knowledge of best practise can be shared between general practises.
There several main types of focus that doctors in general practises can aim at when looking at performance indicators. These are mainly a clinical focus, a patient focus, an economic focus; a capacity and capability focus and finally key targets. If the indicators concentrate on a clinical focus then they are likely to be examining doctors’ style of practise by looking at the types of treatment and service that they use and the outcome of care. This then gives the doctors meaningful information on their clinical performance to help improve the quality of service that they provide. Purchasers can also use this clinical focus as a tool to control costs and ensure they are getting value for money. These type of performance indicators can also be seen to relate to a patient focus of performance as the information provided can be used by patients in their selection of doctor or particular doctor’s surgery. When looking at patient focus you also need to look at using your patients to give feedback on the services you provide. Doctor’s can also make their performance indicators have an economic focus, which examine the financial aspects of a doctor’s practise. A capacity and capability focus would look at the volume of patients that could be dealt with and how effectively this can be done Alternatively, key targets involve setting individual doctor’s or their practises certain goals to reach and then using performance indicators to see if they have reached this target.
There are many different performance indicators that a doctor’s practise could use. In terms of access they could look at waiting times for appointments, the range of services on offer, patients perceptions of access as well as appointment rates for specific populations (age, gender, diagnosis, culture). When looking at quality and appropriateness performance indicators that could be used are the availability of appropriate services/specialists, the number of complaints received, patient’s perceptions of quality/appropriateness, and levels of access to other health services. Other performance indicators that could be used could involve the outcomes of treatment, such as the speed of treatment, the amount of adverse outcomes from treatment and consumers perceptions of their treatment. Indicators that doctors can use to deal with Structure/Plan management could be things such as cost per unit of service, the cost per customer and administrative costs. GP’s could also use indicators involving early intervention/prevention such as the use of self-help and the identification of high-risk populations.
Other performance indicators that could be used include the amount of missed appointments and readmission’s, cleanliness, staff opinion surveys, budgets, consultant appraisals and health and safety. Finally doctors’ profiles could be made available to the public to help their evaluation of physicians. These profiles could include things like years in practise and any history of malpractice.
- As performance indicators are implemented, a major aspect in their definition and selection is the burden and cost associated with collecting and analysing the data needed to measure. Therefore with any of the indicators mentioned in part c), a doctor may find them too costly to develop. They may also find that they don’t have the ability to obtain and report the data in a timely way. It could be seen how carrying out extensive surveys and questionnaires would probably not be cost effective for a general practise. Also as there is likely to be a considerable variety in the use of performance indicators by doctor’s surgery’s then they may find that without a standardised set of indicators that the whole system would have to undergo a major transformation if doctors wanted to share the information so that they could implement a best practise approach.
Another problem with the performance indicators mentioned in part c) is that different patient groups would not benefit equally from performance indicators. This is because, as has been found in the United States, vulnerable groups such as the poor, less educated, or chronically sick people and members of some minority ethnic groups are least likely to make use of the data. This would mean the groups with the greatest need for healthcare make the least use of the performance indicators. This would mean that the indicators would have to target consumer and patient groups, rather than individual people.
Doctor’s practises could also find that when trying to use performance indicators there would be problems with non-comparability. This is due to reasons like, local differences in organisation structure and in bookkeeping systems which means some costs are classified differently and also because most doctors surgery’s are distinctly different due to things like their size and the number of doctor’s that work in them. This means that it would be very hard to benchmark one doctor’s surgery performance against another, which would also make it hard to use the indicators to implement a best approach practise.
Another problem that a doctor’s surgery may have when trying to implement performance indicators is the lack of consensus there is likely to be over which indicators should be used. This is because there are various stakeholders in a doctor’s surgery who will often have different expectations. One stakeholder in a doctor’s surgery may consider a system successful if waiting times are shortened and health and safety improved. Where as another may say the indicators are successful if costs are contained. These different values and expectations result in different choices of indicators and a greater importance given to specific indicators.
In conclusion, performance indicators are a tool to measure, evaluate and monitor how successfully an organisation is performing. People want organisations to produce these for several purposes. These are including accountability, quality, improvement, planning, budgeting, marketing, contract negotiations and management, purchasing services, choosing providers, policy making, and research. The fact, however that performance indicators can be used for these various functions it does not mean that the performance measurement system will take the entire burden. There are many different performance indicators that a doctor’s surgery could use. These vary from looking at patient and staff’s perceptions of the doctor’s surgery as well as the cost per consumer and missed appointments. Doctor’s surgeries may, however, find that problems may arise when they try to use these performance indicators. Such problems include trying to satisfy a large variety of patients, loss of time, impractical costs and incomparability with other doctor surgery’s performance indicators.
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McGlynn, E.A. Choosing and evaluating clinical performance measures. Joint Commission on Quality Improvement. 1998