• Advanced healthcare systems are moving toward greater efficiency, transparency and accountability, and this trend will continue, particularly in fiscally-constrained environments

• There is no single measure that will improve service delivery and patient outcomes, ensure financial sustainability and increase accountability and transparency in a health system

• Performance reporting in healthcare will work if properly developed and implemented keeping the following twelve lessons in mind:

Program design

• Understand the social, political and economic considerations carefully before setting targets, monitoring performance and reporting on them
• Strive for mandatory, system-wide participation
• Allow health providers and organisations to drive improvements in a devolved manner, which are patient-centred
• Strive for more than just wait-time measures—such measures could include re-admission rates, ward infection rates and in-hospital death rates
• Include both public and non-public performance reporting mechanisms
• Be mindful of minimising dysfunctional, unintended consequences
• Always pilot before rolling out

Data collection and reporting

• Strive for continual design, accuracy and relevancy testing of measures and the way data are collected and reported
• Ensure data collection is not an end in itself but a driver of positive change within the health system, and avoid onerous data collection and reporting overburden
• Real-time reporting should be the goal, which delivers comparative clinical performance data back to health service providers and organisations

Stakeholders

• Engage key stakeholders, especially clinicians and senior leadership, but also the media and general public
• Change the culture of provider organisations to foster learning over punishing and judging, which also allows clinical staff to raise questions and concerns