Health service performance indicators

The development of statistical indicators for monitoring performance throughout the National Health Service began in 1981. In recent years, computer software packages containing performance indicators have been amended to include Health and Social Services Boards in Northern Ireland. Although this information is available to anyone with an interest in service provision, the main purpose of the indicator packages is to provide a framework and discipline for ensuring proper accountability to a higher tier authority. Efficiency and effectiveness are concepts central to performance appraisal. Most performance indicators are concerned with the input of resources or treatment activity rather than health outcome. Consequently the context within which the accountability review procedure operates is predetermined towards efficiency. The validity of the review process is limited by the accuracy of the indicators and the manner in which they are interpreted. The scale at which performance indicators function and the constraints associated with their use as an analytic tool are illustrated using data from a mental illness hospital in Northern Ireland.