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This paper provides an overview of the development of performance measurement in the Irish health sector, drawing on reported developments in other health systems. Performance measurement has considerable potential in health service management in enabling national priorities for health reform to be translated into organisational and individual objectives, to provide a focus on results, and to enhance accountability. The paper begins by positioning the development of performance measurement within the range of recent policy and legislative changes in the Irish health sector. Drawing on the international literature, four key aspects of performance measurement are identified, which form the framework for the study: developing performance measurement systems; measure definition and data collection; developing the use of performance data; and co-ordinating performance measurement. Performance measurement was also reviewed at the national system level, the organisation level and the individual level. The range of approaches currently in place to measure performance is outlined, and includes: · systems to monitor health outcomes and progress against strategic priorities at the national level, such as the Public Health Information System (PHIS) and strategy indicators used for the National Cancer Register · systems to monitor the performance of programmes/service areas, such as the hospital inpatient enquiry system (HIPE) and datasets being developed for mental health services and intellectual disability services · systems to monitor performance at the health board and agency level, such as integrated management returns (IMRs) and service plan indicators. A comparative review was undertaken of the development of performance measurement systems in Australia, New Zealand, the United Kingdom, the USA and Canada. The report concludes that the focus of performance measurement across these countries is on improving health outcomes, improving the quality of care, achieving national priorities and reducing inequalities in health. The findings also suggest that performance measurement systems are largely evolving around: · developing national frameworks to define standards of expected performance · developing good measures and data collection systems · building managerial capacity to manage performance. The findings highlight the need for strong leadership in promoting the development of performance measurement and developing frameworks to ensure that health care providers comply with good performance standards. Currently, performance measurement tends to be focused around acute health care, but there is increasing interest in extending performance measurement to all parts of the health care system. The report looks at the approach taken across countries to developing performance measures. The concepts of performance measured include health improvement/outcomes, effectiveness and quality, the patient orientation of services, access and financial/resource management. Similar concepts are seen in the range of measures currently being used in the Irish health service, although coverage appears patchy. The area that needs to be developed in particular in the Irish health sector is the patient-orientation of services. The types of measures used across countries include rates; averages; medians or means; proportions; costs; composite measures; and other measures of performance. Similar measures are currently used in the Irish system although composite measures have yet to be developed. In terms of the development of performance measures the findings emphasise the need to move beyond an emphasis on finance and activity towards more balanced sets of measures and to focus on generating information that is useful to decision-makers. The findings also highlight the need to shift the emphasis from compliance with processes to focusing on results, and that performance measures should relate to key objectives in order to drive strategy forward. The report highlights the need to have good quality data available at all levels of the system to support performance measurement. In terms of collecting, aggregating and disseminating data it is reported that data management systems are largely underdeveloped and fragmented. The acute hospital sector is where performance measurement is most developed. The need for a co-ordinated approach to the development of data management systems across the health system is identified. The findings suggest that data currently available on performance is under-utilised and focused mainly on controlling expenditure. A number of points are raised about how the use of data can be improved. The decision-usefulness of data is an important issue. Data must be relevant to users and at the correct level of detail. Data also needs to be timely and easily accessible to those who need it. In addition, the managerial culture needs to be receptive to the importance of basing decisions on performance data, individuals need to feel empowered, and the appropriate skills and expertise are required to be able to interpret data and use the findings constructively. Data must be reliable and individuals need to have confidence in using it. At the individual level it is suggested that performance measurement needs to be developed and linked to performance management and personal development planning. The research found that performance measurement at the individual level is largely underdeveloped. The findings emphasise the need for improved co-operation and collaboration across the health sector in the development of performance measurement. A number of areas must be addressed in this regard, including the need for greater clarity in defining who is responsible for co-ordinating performance measurement across the system. The report concludes that the key issues to be addressed are: · clarifying responsibility for overall co-ordination of performance measurement · extending performance measurement to all areas of the health system · extending performance measurement to the individual level within organisations and linking it with performance management

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