ABSTRACT
Over the past two decades or so beginning with David Osborne’s book Reinventing Government (1993), public managers have increasingly been held accountable for the performance of their programs, especially in an era of competition, scarce resources, privatization, and performance-based management. Federally funded health care programs are no exception. With a new national administration taking office in 2009, regardless of the party or candidate in office, performance is likely to continue to be an important goal, especially in health care. In this chapter, we look closely at an innovative performance-based management initiative in the delivery of HIV/AIDs services in the Boston area. The Boston initiative provides valuable insights into the design and implementation of a performance system at the local level, something often not given much attention in national debates about health care reform. We discuss challenges and successes-political and technical-encountered during the ten-year evolution of the performance-measurement system. We present data to illustrate the complexity of service delivery to a chronically ill population, clarify the struggle in identifying and serving diverse needs of individual clients, and stress the importance of continuously assessing and modifying the system. The chapter concludes with lessons learned and prospects for the future.
