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date: 22 June 2021

Abstract and Keywords

This chapter examines an important paradox of performance measurement and management in health care—the problem of simultaneous overload and deficit. To understand why this paradoxical situation exists, the chapter begins with a consideration of accountability and how this has changed as the performance movement has grown. It then examines why performance is being measured, what is being measured, and some fundamental problems with performance measurement. Finally, it considers the relationship between performance measurement and performance management. It concludes that this paradox of both too much and too little is inherent to measuring and managing performance, particularly in health care. This problem can be mitigated with more contextually specific approaches and greater local flexibility and dialogue. But it cannot be easily solved in highly centralized systems where such changes amount to a loss of control and a concomitant increase in social, economic and political risks.

Keywords: accountability, deficit, England, NHS, overload, paradox, performance management, performance measurement

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