Table 2

Differentiating uses of healthcare performance indicators across healthcare systems

ContextPurpose of useIllustrative usesIllustrative usersIllustrative information need
MacroSystem 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?
MesoRegulation (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?
MicroPractice 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-cuttingResearch.Exploring the use of indicators across contexts.Academia and academic networks; think tanks, research groups; topic-specific associations.Secondary user-directed.