Assessing the performance of NHS Hospital Trusts: the role of 'hard' and 'soft' information

Formal performance measurement systems have become a prominent feature thro ughout most of the public sector. The NHS is no exception and the governmen t is developing and expanding on existing performance data to produce a new national framework which is to be at the heart of the 'performance-led' NH S. The success of formal performance measurement systems depends in part on the degree to which they can capture adequately relevant information withi n a quantitative framework. In this paper, we explore the use of formal, qu antitative 'hard' information and informal, subjective 'soft' information i n the assessment of the performance of NHS hospital Trusts by external orga nisations. Our empirical work is summarised into 3 main themes: (i) the use of 'soft' information as a complement to 'hard' information; (ii) the use of 'soft' information as a substitute for 'hard' information; and (iii) the use of 'hard' information as a safety net in the assessment of performance . We argue that 'soft' information plays a valuable role in the assessment of performance of NHS Trusts and note that this is also reflected in curren t practice in the private sector. We argue that one of the main functions o f 'hard' information in performance assessment is to act as a safety net in order to identify laggards by highlighting poor performance. Rarely is it used as a means to encourage good performance or to identify best practice. Whilst the safety net function may indeed be useful, if the new national p erformance framework is to achieve its aim of promoting good performance, t he limitations of formal systems will have to be taken into account. We arg ue that the advantages of 'soft' information in the NHS should be acknowled ged, rather than trying to force it into a formal framework where the benef its may be nullified. However, we also warn against excessive reliance on ' soft' information and suggest that a balanced system which allows both 'har d' and 'soft' information to flourish is the optimal solution to performanc e assessment in the NHS. (C) 1999 Elsevier Science Ireland Ltd. AU rights r eserved.