Performance measurement and management of healthcare professionals - Some topical issues

Healthcare professionals are increasingly held accountable for the standard s of care that they provide. The focus of control for this accountability c an be either internal or external activity to the professional body and can use implicit or explicit quality assessment techniques. The science of per formance measurement and performance management of professional activity is a new and rapidly expanding one. Advocates of an actively managed approach to quality improvement often underestimate the tensions associated with pr omoting change amongst traditionally autonomous professionals who work in c omplex organisations. This tension has tended to result in polarised opinio ns about complex issues rather than legitimate debate. There is considerable uncertainty about the most effective ways of measurin g professional performance and the relationship between measurement and qua lity improvement. This article examines some of the important issues in mea suring clinical performance and using such measures to manage healthcare ac tivity and promote quality improvement. This article is intended to shed li ght on the rapidly changing, data-rich environment within which healthcare systems now operate, and it highlights a number of questions that need to b e addressed before the full potential of performance management in healthca re can be realised.