Governing performance management in primary care – towards a framework for international comparison

Performance management has become an increasingly common in health care systems since the 1980s. Hospitals were long the key locus of performance management in health, but since 2000 policymakers have increasingly focused on... [ view full abstract ]

Performance management has become an increasingly common in health care systems since the 1980s. Hospitals were long the key locus of performance management in health, but since 2000 policymakers have increasingly focused on the management of performance primary care.

The bulk of literature on the use of performance management in primary care has focused on the implementation of the Quality and Outcome Framework (QOF) in England and Scotland, primarily consisting of qualitative case studies at the organisational level. However, research that focuses on policy processes (the definition of problems and development of solutions) is scant, and there are few studies of implementation of primary care performance management beyond the United Kingdom. For researchers and policymakers with an interest in this area, it is currently difficult to synthesise information about what is happening across a broader range of jurisdictional contexts.

Our aim is to develop the conceptual scaffolding for future comparative research into performance management in primary care. We argue that it is necessary to do this because there is a broad range of justifications for the use of performance management (as well as a broad range of critique), and considerable variation internationally regarding the modes of governance (hierarchical, network, market) adopted in both the development and implementation of performance management regimes. Taking into account the institutional variation in primary care systems, the impact and broader consequences of performance management in primary care is likely to vary significantly across jurisdictions.

Our proposed comparative framework incorporates temporal, substantive, structural, spatial and professional dimensions of jurisdictional context; problem definitions that prompt the development of performance management; and the mixes of policy instruments and modes of governance used in implementation. In this paper we will use this framework in order to compare developments in primary care performance measurement in Denmark and New Zealand.