A balanced judgement? Performance indicators, quality and the English ambulance service; some issues, developments and a research agenda

Abstract

A significant feature of the 'New Public Management' has been the particular emphasis it placed on public sector organisations measuring their performance. However, in practice, this has often been carried out in ways which proved dysfunctional: for example, by concentrating on a single dimension of performance, perverse incentives and unintended consequences arise.
The previous performance measurement regime for the English ambulance service was regarded as a classic example of this since it concentrated on response times at the expense of other aspects of performance, such as the outcomes of treatment at the scene. However, that regime has been replaced by a 'dashboard', containing a wider range of performance indicators. At the same time, NHS organisations (including ambulance services) have to produce annual Quality Accounts. Thus English ambulance services are now faced with two new performance measurement regimes. Both of these seem, in principle, an improvement on the old regime; but also seem somewhat contradictory in their 'philosophies'.
These developments are worthy of further exploration and, in this paper, we set out a research agenda, whilst placing the issues in the context of debates concerning multi-dimensional approaches to performance evaluation, such as the Balanced scorecard and Tableau de Bord, and, more generally, the 'paradox of performance' in public services.