TRUST IN PERFORMANCE INDICATORS

The 1980s and 90s have seen the proliferation of all forms of performa nce indicators as part of attempts to command and control health servi ces. The latest area to receive attention is health outcomes. Publishe d league tables of mortality and other health outcomes have been avail able in the United States for some time and in Scotland since the earl y 1990s; they have now been developed for England and Wales. Publicati on of these data has proceeded despite warnings as to their limited me aningfulness and usefulness. The time has come to ask whether the reme dy is worse than the malady: are published health outcomes contributin g to quality efforts or subverting more constructive approaches? This paper argues that attempts to force improvements through publishing he alth outcomes can be counterproductive, and outlines an alternative ap proach which involves fostering greater trust in professionalism as a basis for quality enhancements.