Introduction

Performance monitoring has been driven by both scandal and science. Some high-profile failures such as Mid Staffordshire NHS Hospitals Trust in England and King Edward Memorial Hospital in Australia have piqued the public’s interest. Since the 1990s, the United Kingdom alone has had three public inquiries over what went wrong and why it was not detected earlier. Landmark studies and reports of the considerable apparent dangers of being in hospital helped transform the famous instruction to first do no harm (“Practice two things in your dealings with disease: either help or do not harm the patient”) into a global patient safety movement (Institute of Medicine, 2000). It’s been known for some time that healthcare regularly falls short of its own standards in terms of not following clinical guidelines as often as they should be. In the words of the Institute of Medicine, the difference “between healthcare we have and the care we could have is not just a gap but a chasm” (Corrigan et  al. 2001). This has been found in all sectors and all countries (Lee and Mongan 2012). As a result, healthcare has looked to other fields such as aviation and manufacturing to reduce the risk of harm and to raise standards in general. As the range, complexity and healing power of modern medicine have expanded, patients’ expectations have risen. The financial costs of healthcare systems around the world escalate,

and each system tries to do more with less. The system also needs to justify costs in terms of what it “produces” and how well it does it. All of this means that monitoring performance is needed more than ever.