ABSTRACT
Monitoring healthcare performance is in general complicated and expensive, so we need to know whether it achieves what we hope it achieves without too much in the way of adverse effects. As we saw in earlier chapters, performance targets and incentive schemes distort behaviour, from the submission of suspicious-looking data (e.g., peak in emergency department waiting times just before the four-hour target) to taking our eyes off the ball regarding non-incentivised areas (e.g., those conditions not covered by P4P schemes). It’s vital to capture such unintended consequences in the evaluation. Regarding the intended consequences, part of the evaluation will consist of a before versus after comparison of indicators using the same quantitative data as in the monitoring. As such data are unlikely to tell the whole story, the other part will consist of the collection and analysis of qualitative and/or additional survey data on factors such as staff attitudes and patient experience. Introducing a monitoring system will lead to far-reaching effects on the healthcare system and as such is akin to introducing a complex healthcare intervention. Examples of such interventions include redesigning a service involving multiple providers or efforts to improve public health by a national screening or health promotion campaign.
