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The performance of NHS UK hospitals is under continuous scrutiny as they are constantly under pressure to perform well. A recent document published by an independent body has recommended a host of clinical indicators to assess non‐financial performance of hospitals. This study aims to critically analyse the performance of a single UK hospital against several of these recommended indicators.

Data presented to the Hospital Trust Board for 12 months were used for this study. Previous years' data were used wherever available.

Based on data analysis, this hospital's performance is extremely difficult to calculate. The indicators use complex ratios and due to lack of standardisation, the hospital performance could be interpreted as better, worse or indifferent.

This study analyses most of the recommended indicators. Literature review did not reveal a similar analysis of another hospital against these indicators which precludes comparison.

This study highlights the difficulty in comparing the performance of hospitals due to the inherent lack of consistency. Therefore it is apparent that any reward‐rebuke system linked to performance should interpret the data with caution. It is therefore suggested that easy to control single value activities and standardised routine activities could be used to measure hospital performance. Alternatively, the hospital could compare with its own statistics from previous years.

Literature acknowledges the difficulties in measuring clinical performance. This paper elucidates these difficulties applied to the NHS and suggests alternatives.

The purpose of this paper is to examine the question of how official bodies, health care organisations, and professional associations deal with the absence of a methodological gold standard for the simultaneous development of clinical practice guidelines and quality indicators, what procedures they use and what they feel are major strengths and limitations of their methods.

The authors conducted a web‐based survey among 90 organisational members of the Guidelines International Network (G‐I‐N) representing 34 countries from Africa, America, Asia, Europe and Oceania. All organisational G‐I‐N members were invited to participate in the survey by following a link provided in the invitation e‐mail.

The responses of 24 organisations were included in the final analysis. The results indicate a broad variability in the approaches and methods used to develop quality indicators and guidelines simultaneously. The answers of the participants indicated a lack of formal procedures for the simultaneous development. Formal procedures exist in only about half of the participating organisations. In addition, piloting or evaluation of the procedures is almost completely missing. Significantly, respondents mainly reported that the procedure used in their organisation “could certainly be more rigorous”. Besides various strengths, participants reported a considerable number of limitations of the development processes they use.

This survey among G‐I‐N members – despite limitations – gives helpful insights in the state of the simultaneous development of quality indicators and clinical practice guidelines and underlines the need for future activities in methodological standard development and quality improvement of these processes.

Clinical governance should be based on cultural elements that value lifelong learning, skill development and research. The purpose of this paper is to introduce a set of indicators to improve educational governance in hospitals.

Key indicators were identified from the international and national literatures. Later, the indicators were rated and prioritized by a multidisciplinary panel of medical professionals using two rounds of Delphi technique. Subsequently at two consensus meetings, the panel evaluated the indicators.

A set of 51 draft indicators were identified. The expert panel members rated 28 indicators as high priority indicators for measuring educational performance of the hospitals.

This set of indicators can be used to measure the educational performance of the hospitals in identifying the gaps and take steps to resolve them.

Education and training is the basic component of clinical governance. Hospital staff education and training is a fundamental step towards organizational and individual development. To improve the educational performance at hospital level it is necessary to reliably measure such performance. This can be done through developing and using relevant indicators. There are limited systematic studies, especially in middle and low income countries, to introduce appropriate indicators. This study has investigated developing a set of indicators to measure and improve the educational performance in hospitals.

The performance construct may be one of the most elusive in organization theory. Health care organizations are particularly complex owing to their dual lines of accountability, i.e. professional and administrative. This article examines the factors affecting performance indicator development and use at the technical/managerial and institutional levels, including the accreditation process and the relationship between levels. Using institutional and rational/goal theory, the motivations behind performance measurement behavior at different organizational levels was explored. Results show that the institutional level is motivated by legitimacy while the technical/managerial level is motivated by rationality. Tensions exist between the two levels and between indicator development and use.

Describes a process of adopting a set of review criteria for use in a regional project to improve heart failure management in general practice. Published guideline review criteria were assessed using a protocol examining indicator relevance, practicality and the clinical evidence on which indicators were based. An expert panel with experience in general practice, cardiology and general internal medicine, ethics, and research methodology was used to evaluate the indicators. Good overall agreement was observed with the review criteria. Areas of disagreement related to poor wording of the criteria, the need to incorporate more up‐to‐date evidence and criteria based on weak evidence. A need exists for greater training of health practitioners about how regional indicators can be used as screening tools for quality improvement. Nationally endorsed sets of regularly updated review criteria for common and important conditions would be helpful in guiding similar quality improvement projects.

The purpose of this paper is to identify and describe hospital quality indicators, classifying them according to Donabedian’s structure, process and outcome model and in specific domains (quality, safety, infection and mortality) in two care divisions: inpatient and emergency services.

A systematic review identified hospital clinical indicators. Two independent investigators evaluated 70 articles/documents located in electronic databases and nine documents from the grey literature, 35 were included in the systematic review.

In total, 248 hospital-based indicators were classified as infection, safety, quality and mortality domains. Only 10.2 percent were identified in more than one article/document and 47 percent showed how they were calculated/obtained. Although there are scientific papers on developing, validating and hospital indicator assessment, most indicators were obtained from technical reports, government publications or health professional associations.

This review identified several hospital structure, process and outcome quality indicators, which are used by different national and international groups in both research and clinical practice. Comparing performance between healthcare organizations was difficult. Common clinical care standard indicators used by different networks, programs and institutions are essential to hospital quality benchmarking.

To the authors’ knowledge, this is the first systematic review to identify and describe hospital quality indicators after a comprehensive search in MEDLINE/PubMed, etc., and the grey literature, aiming to identify as many indicators as possible. Few studies evaluate the indicators, and most are found only in the grey literature, and have been published mostly by government agencies. Documents published in scientific journals usually refer to a specific indicator or to constructing an indicator. However, indicators most commonly found are not supported by reliability or validity studies.

There is growing focus on the importance of attending to “patient experience” in delivery of health services, and the design of clinical quality indicators. “Patient experience” (also termed “user experience”) has been augmented by “staff” and “carer” experience in the “service experience” quality indicator for emergency care in England. But “patient experience” is a contested concept which patients, clinicians, politicians, managers and academics view differently.

The purpose of this paper is to examine approaches to thinking about patient experience. The author describes three key approaches to conceptualising patient experience and identify their philosophical origins, then asks what aspects of patient experience ought to be treated as key to measuring the quality of emergency care. The discussion is illustrated with extracts from a patient interview describing emergency care following placental abruption.The author demonstrates that differing purposes and differing conceptions of care direct attention to different aspects of patient experience.

Donabedian's insight was that conceptions of quality are inevitably related to conceptions of value and the author concurs, arguing that decisions about which aspects of patient experience to include in clinical quality indicators are ethical as well as technical judgements.

This paper is of value to those concerned with quality improvement because it clarifies the meaning of patient experience in the context of care quality measurement, and highlights the ethical implications of experiential data.

It is a novel synthesis of understandings of patient experience and clinical quality in emergency care.

The article features a study based on postal questionnaires and structured interviews, targeting senior members of the hospital pharmacy profession. The aim was to examine the potential of practice and performance benchmarking as a means of improving competence and capabilities within the clinical pharmacy service of NHS Trust hospitals. Postulation of models and analysis of data is followed by discussion of results. This leads to a number of suggestions and conclusions with respect to the potential role of benchmarking including an assessment of its suitability, limitations, and implementation issues associated with this particular service sector.

The purpose of this paper is to assess the performance measurement in the UK NHS ambulance service documenting various unintended consequences of the current performance framework and to suggest a future research agenda.

The paper reviews the literature on ambulance performance targets and documents several unintended consequences of the current performance system through an in‐depth case study analysis based on interviews with Trust staff and policy experts along with observation of performance review meetings in the chosen Trust. Ethical approval for the study was obtained from a local NHS research ethics committee.

Significant unintended consequences of the ambulance performance targets based on response times have been systematically documented, which are likely to put the target under spotlight, especially that of the eight‐minute response. The current policy focus to reform the eight‐minute target by making it more stringent has the potential of jeopardising the reform agenda based on developing clinical skills of the paramedics and introducing clinical management in the service.

The paper makes an objective assessment of the sustainability of the current policy framework and identifies future lines of enquiry for further research.

This paper makes an original contribution in identifying and documenting the disjuncture between stated and unintended consequences of ambulance performance measurement, which will be of value to academics, practitioners and policy makers.

In a context of international economic crisis the improvement in the efficiency and productivity of public services is seen as a way to maintain high-quality levels at lower costs. Increased productivity can be promoted through benchmarking exercises, where key performance indicators (KPIs), individually or aggregated, are used to compare health units. The purpose of this paper is to describe a benchmarking platform, called Hospital Benchmarking (HOBE), where hospital’s services are used as the unit of analysis.

HOBE platform includes a set of managerial indicators through which hospital services’ are compared. The platform also benchmarks services through aggregate service indicators, and provides an aggregate measure of hospital’s performance based on a composite indicator of the service’s performances. These aggregate indicators were obtained through data envelopment analysis (DEA).

Some results are presented for Portuguese hospitals for the trial years of 2008 and 2009, for which data is publicly available. Details for the service-level analysis are provided for a sample hospital, as well as details on the aggregate performance resulting from services performances.

HOBE’s features and outcomes show that the platform can be used to guide management actions and to support the design of health policies by administrative authorities, provided that good quality and timely data are available, and that hospitals are involved in the design of the KPIs.

The platform is innovative in the sense that it bases its analysis on hospital’s services, which are in general more comparable among hospitals than indicators of hospital overall performance. In addition, it makes use of DEA to aggregate performance indicators, allowing for user choice in the inputs and outputs to be aggregated, and it proposes a novel model to aggregate service’s efficiencies into a single measure of hospital performance.