ABSTRACT
Formal performance measurement systems are increasingly a prominent feature of health systems concerned with raising quality and containing costs. This chapter describes the rise of performance indicators in the NHS. It then examines the role of ‘hard’ and ‘soft information in assessing hospital performance and explores the possible unintended and adverse consequences associated with the use of performance indicators. A clear and dominant theme arising from our study is that hard information, used in isolation, is seen as an inadequate and sometimes misleading indicator of Trust performance. Regional office staff reported that they examined closely the hard financial information provided by individual Trusts in order to assess whether they are meeting their targets. Informal social networks should be valued in their own right as a form of ‘social capital’ which has been shown to be a vital lubricant of complex economic relationships. The chapter advocates a cautious approach to the use of performance indicators in the NHS.
