Differentiating uses of healthcare performance indicators across healthcare systems
| Context | Purpose of use | Illustrative uses | Illustrative users | Illustrative information need |
| Macro | System performance monitoring. | Signalling the performance of the system as a whole; comparing performance internationally; publicly reporting system performance. | Public; ministry of health; regional (provincial, state) authorities; health service executive (authority). | How is my healthcare system doing? How does it compare with others? |
| Strategy development. | Setting health policy priorities; identifying emerging health priority areas; and monitoring trends in current priority areas. | Government and ministries; regional (provincial, state) authorities; accountable care organisations; health maintenance organisations. | Have I chosen the right areas to prioritise? What is the impact of strategies that are in place? | |
| System quality assurance. | Measuring care processes; reporting of incidents and never events. | Quality inspectorate; national quality observatory; health and safety executive. | Is care being delivered as intended? Where do problems in the delivery of care lie? | |
| Meso | Regulation (professional, facility, pharmaceuticals). | Informing accreditation, certification and/or licensing processes. | Medical councils, chambers, college of physicians; medicines and healthcare products regulatory agency. | Does the performance of organisations, facilities, medicines, etc, meet established standards? |
| Professional development. | Reporting internally and benchmarking within profession or specialty. | Societies of medical professionals; professional associations; training institutions. | How do healthcare professionals of a specific specialty perform? | |
| Quality-based financing. | Issuing performance-based payment (pay-for-performance); value-based contracting. | Healthcare insurers; healthcare providers. | Are existing guidelines or standards being adhered to? Does this merit the issuing of incentives? | |
| Organisation/network performance improvement. | Improving performance of hospitals, networks and care groups; assessing local needs and geographical differences. | Hospital management; integrated care; networks/groups; local collaboratives of care. | Are affiliated practices/facilities performing optimally? | |
| Micro | Practice or team performance improvement. | Convening audit and feedback, plan-do-study-act, and/or collaborative, team-based improvement cycles; comparing across practices. | Primary care practices; specialist departments or units; pathways of care. | How is my team performing? How can we improve our performance? How do I perform relative to my team members? |
| Individual performance improvement. | Identifying trends in the management of patients; tailoring services to target groups. | Individual physicians; nurse/practitioners; other healthcare professionals. | How am I managing my practice panel? How can I improve my performance? | |
| Informed choice. | Selecting a healthcare provider; participating in care decision-making; self-managing care needs. | Patients; family members and carers; public. | What treatment options or providers are best for me? | |
| Cross-cutting | Research. | Exploring the use of indicators across contexts. | Academia and academic networks; think tanks, research groups; topic-specific associations. | Secondary user-directed. |