Skip to main content Accessibility help
×
Home

Reputations count: why benchmarking performance is improving health care across the world

  • Gwyn Bevan (a1), Alice Evans (a2) and Sabina Nuti (a3)

Abstract

This paper explores what motivates improved health care performance. Previously, many have thought that performance would either improve via choice and competition or by relying on trust and altruism. But neither assumption is supported by available evidence. So instead we explore a third approach of reciprocal altruism with sanctions for unacceptably poor performance and rewards for high performance. These rewards and sanctions, however, are not monetary, but in the form of reputational effects through public reporting of benchmarking of performance. Drawing on natural experiments in Italy and the United Kingdom, we illustrate how public benchmarking can improve poor performance at the national level through ‘naming and shaming’ and enhance good performance at the sub-national level through ‘competitive benchmarking’ and peer learning. Ethnographic research in Zambia also showed how reputations count. Policy-makers could use these effects in different ways to improve public services.

Copyright

Corresponding author

*Correspondence to: Gwyn Bevan, Professor of Policy Analysis, Department of Management, London School of Economics and Political Science, London WC2A 2AE, UK. Email: R.G.Bevan@lse.ac.uk

Footnotes

Hide All

This paper is a revised version of a paper presented at the LSEHSC International Health Policy Conference 2017, London School of Economics and Political Science, 16–19 February 2017.

Footnotes

References

Hide All
Akerlof, G.A. and Kranton, R.E. (2010), Identity Economics: How Identities Shape Our Work, Wages, and Well Being, Woodstock: Princeton University Press.
Anonymous (2017), ‘The National Health Service: policy transplant’, Economist November 4–10, 5657.
Ashton, T., Mays, N. and Devlin, N. (2005), ‘Continuity through change: the rhetoric and reality of health reform in New Zealand’, Social Science & Medicine, 61(2): 253262.
Auditor General for Wales (2005), NHS Waiting Times in Wales. Volume 1 – The Scale of the Problem. Volume 2 – Tackling the Problem, Cardiff: The Stationery Office.
Ayres, I. and Braithwaite, J. (1992), Responsive Regulation: Transcending the Deregulation Debate, Oxford: Oxford University Press.
Barber, M. (2007), ‘Instruction to Deliver’. London: Politico’s Publishing, p. 335.
BBC News (2007), ‘Blair: In His Own Words’. Friday, 11 May, http://news.bbc.co.uk/2/hi/uk_news/politics/3750847.stm [26 January 2018].
Berwick, D. M., James, B. and Coye, M. J. (2003), ‘Connections between quality measurement and improvement’, Medical Care, 41(1): 130138.
Bevan, G. (2014), ‘The Impacts of Asymmetric Devolution on Health Care in the Four Countries of the UK’, http://www.health.org.uk/sites/health/files/TheImpactsOfAsymmetricDevolutionOnHealthCareInFourCountriesUK.pdf [26 January 2018].
Bevan, G. and Hood, C. (2006), ‘What’s measured is what matters: targets and gaming in the English public health care system’, Public Administration, 84(3): 517538.
Bevan, G. and Hamblin, R. (2009), ‘Hitting and missing targets by ambulance services for emergency calls: effects of different systems of performance measurement within the UK’, Journal of the Royal Statistical Society: Series A (Statistics in Society), 172(1): 161190.
Bevan, G. and Skellern, M. (2011), ‘Does competition between hospitals improve clinical quality?: A review of evidence from two eras of competition in the English NHS’, BMJ, 343: d6470.
Bevan, G. and Fasolo, B. (2013), ‘Models of Governance of Public Services: Empirical and Behavioural Analysis of Econs and Humans’, in A. Oliver (ed.) Behavioural Public Policy, Cambridge: Cambridge University Press, 3862.
Bevan, G., Karanikolos, M., Exley, J., Nolte, E., Connolly, S. and Mays, N. (2014), The Four Health Systems of the United Kingdom: How Do They Compare?, London: Nuffield Trust, http://researchonline.lshtm.ac.uk/1649072/1/140411_four_countries_health_systems_full_report.pdf [26 January 2018].
Bowles, S. (2016), The Moral Economy: Why Good Incentives Are No Substitute for Good Citizens, London: Yale University Press.
Central Statistical Office (CSO), Ministry of Health, University of Zambia Teaching Hospital, University of Zambia Department of Population Studies, Tropical Diseases Research Centre (2015), The DHS Program. Zambia Demographic and Health Survey 2013-14, Lusaka: CSO.
Chassin, M. R. (2002), ‘Achieving and sustaining improved quality: lessons from New York State and cardiac surgery’, Health Affairs, 21(4): 4051.
Chowdry, H., Muriel, A. and Sibieta, L. (2008), ‘Level Playing Field? The Implications of School Funding. CfBT Education Trust’, https://www.researchgate.net/profile/Haroon_Chowdry/publication/39065923_Level_Playing_Field_The_Implications_of_School_Funding/links/5437d69d0cf2d5fa292b6dc2.pdf [26 January 2018].
Clark, J. (2012), ‘Medical leadership and engagement: no longer an optional extra’, Journal of Health Organization and Management, 26(4): 437443.
Cooper, Z., Gibbons, S., Jones, S. and McGuire, A. (2011), ‘Does hospital competition save lives? Evidence from the English NHS patient choice reforms’’, The Economic Journal, 121(554): F228F260.
Department of Health (2002), NHS Performance Ratings. Acute Trusts, Specialist Trusts, Ambulance Trusts, Mental Health Trusts 2001/02, London: Department of Health.
Department of Health (2005), ‘Chief Executive’s Report to the NHS’. Statistical Supplement, May. Department of Health, London, p. 16.
Enthoven, A. C. (1985), Reflections on the Management of the National Health Service: An American Looks At Incentives to Efficiency in Health Services Management in the UK, London: Nuffield Provincial Hospitals Trust.
Evans, A. (forthcoming), ‘Amplifying accountability by benchmarking results at district and national levels’, Development Policy Review.
France, G. and Taroni, F. (2005), ‘The evolution of health-policy making in Italy’, Journal of Health Politics, Policy and Law, 30(1–2): 169187.
Frey, B. (2013), ‘How Should People be Rewarded for Their Work?’, in A. Oliver (ed.), Behavioural Public Policy, Cambridge: Cambridge University Press, 165183.
Fukuda-Parr, S. (2014), ‘Global goals as a policy tool: intended and unintended consequences’, Journal of Human Development and Capabilities, 15(2–3): 118131.
Fung, C. H., Lim, Y. W., Mattke, S., Damberg, C. and Shekelle, P. G. (2008), ‘Systematic review: the evidence that publishing patient care performance data improves quality of care’, Annals of Internal Medicine, 148(2): 111123.
Gaynor, M., Moreno-Serra, R. and Propper, C. (2013), ‘Death by market power: reform, competition, and patient outcomes in the National Health Service’, American Economic Journal: Economic Policy, 5(4): 134166.
Gintis, H., Bowles, S., Boyd, R. and Fehr, E. (eds) (2005), Moral Sentiments and Material Interest: The Foundation of Cooperation in Economic Life, Cambridge, MA: MIT Press.
Ham, C. (2008), ‘World class commissioning: a health policy chimera?’, Journal of Health Services Research & Policy, 13(2): 116121.
Hibbard, J. H. (2008), ‘What can we say about the impact of public reporting? Inconsistent execution yields variable results’, Annals of Internal Medicine, 148(2): 160161.
Hibbard, J. H., Stockard, J. and Tusler, M. (2003), ‘Does publicizing hospital performance stimulate quality improvement efforts?’, Health Affairs, 2(2): 8494.
Hibbard, J. H., Stockard, J. and Tusler, M. (2005), ‘Hospital performance reports: impact on quality, market share, and reputation’, Health Affairs, 24(4): 11501160.
Hood, C. and Dixon, R. (2010), ‘The political payoff from performance target systems: no-brainer or no-gainer?’, Journal of Public Administration Research and Theory. 1, 20(Supplement 2): i281i298.
Le Grand, J. (2003), Motivation, Agency and Public Policy: Of Knights and Knaves, Pawns and Queens, Oxford: Oxford University Press.
Le Grand, J. (2007), The Other Invisible Hand: Delivering Public Services Through Choice and Competition, Woodstock: Princeton University Press.
Le Grand, J. (2010), ‘Knights and knaves return: public service motivation and the delivery of public services’, International Public Management Journal, 13(1): 5671.
Maarse, H., Jeurissen, P. and Ruwaard, D. (2016), ‘Results of the market-oriented reform in the Netherlands: a review’, Health Economics, Policy and Law, 11(2): 161178.
Marshall, M. N., Shekelle, P. G., Leatherman, S. and Brook, R. H. (2000), ‘The public release of performance data: what do we expect to gain? A review of the evidence’, JAMA, 283(14): 18661874.
Miller, E. F. and Hume, D. (1994), Essays: Moral, Political, and Literary, Indianapolis, IN: Liberty Fund.
Ministry of Health (2008), National Reproductive Health Policy, Lusaka: MoH.
Mukonka, V. (2012), Status of Maternal Health in Zambia, Geneva: Countdown to 2015.
Mukonka, V. M., Malumo, S., Kalesha, P., Nambao, M., Mwale, R., Kasonde, M. and Wamulume, P. K. (2014), ‘Holding a country countdown to 2015 conference on Millennium Development Goals (MDGs) – the Zambian experience’, BMC Public Health, 14: 60.
Murante, A. M., Vainieri, M., Rojas, D. and Nuti, S. (2014), ‘Does feedback influence patient – professional communication? Empirical evidence from Italy’, Health Policy, 116(2): 273280.
Nuti, S., Seghieri, C. and Vainieri, M. (2013), ‘Assessing the effectiveness of a performance evaluation system in the public health care sector: some novel evidence from the Tuscany region experience’, Journal of Management & Governance, 17(1): 5969.
Nuti, S., Vola, F., Bonini, A. and Vainieri, M. (2015), ‘Making governance work in the health care sector: evidence from a “natural experiment” in Italy’, Health Economics, Policy and Law, 11(1): 1738.
Nuti, S., Bini, B., Ruggieri, T.G., Piaggesi, A. and Ricci, L. (2016), ‘Bridging the gap between theory and practice in integrated care: the case of the diabetic foot pathway in Tuscany’, International Journal of Integrated Care, 16(2): 9.
Oliver, A. (2007), ‘The Veterans health administration: an American success story?’, Milbank Quarterly, 85: 535.
Oliver, A. (2015), ‘Incentivising improvements in health care’, Health Economics, Policy and Law, 10(3): 327343.
Oliver, A. (2017), ‘Do unto others: on the importance of reciprocity in public administration’, American Review of Public Administration, doi: 10.1177/0275074016686826.
Pinnarelli, L., Nuti, S., Sorge, C., Davoli, M., Fusco, D., Agabiti, N., Vainieri, M. and Perucci, C. A. (2012), ‘What drives hospital performance? The impact of comparative outcome evaluation of patients admitted for hip fracture in two Italian regions’, BMJ Quality & Safety, 21(2): 127134.
Pollock, A., Macfarlane, A., Kirkwood, G., Majeed, F.A., Greener, I., Morelli, C., Boyle, S., Mellett, H., Godden, S., Price, D. and Brhlikova, P. (2011), ‘No evidence that patient choice in the NHS saves lives’, The Lancet, 378(9809): 20572060.
Sarwar, M. B. (2015), ‘National MDG Implementation: Lessons for the SDG Era’, Working Paper No. 428, Overseas Development Institute, London, p. 10.
Schultze, C. L. (2010), The Public Use of Private Interest (Quoted by Enthoven). Volume 1976. Washington: Brookings Institution Press.
Skellern, M. (2016), ‘The Hospital as a Multi-Product Firm: Measuring the Effect of Hospital Competition on Quality Using Patient-Reported Outcome Measures’, mimeo, June 2015, London School of Economics and Political Science, London.
Smee, C (2008), ‘Speaking Truth to Power’, in N. Timmins (ed.), Rejuvenate or Retire? Views of the NHS at 60. London: Nuffield Trust.
Smith, A. (2005), Wealth of Nations, Chicago: University of Chicago Press.
Smith, J. and Curry, N. (2011), ‘Commissioning’, in Dixon A., Mays N. and Jones L. (eds) Understanding New Labour’s Market Reforms of the English NHS, London: King’s Fund, 3051.
Spurgeon, P., Mazelan, P. M. and Barwell, F. (2011), ‘Medical engagement: a crucial underpinning to organizational performance’, Health Services Management Research, 24(3): 114120.
Stevens, S. (2004), ‘Reform strategies for the English NHS’, Health Affairs., 23(3): 3744.
Tankard, M. and Paluck, M. E. (2016), ‘Norm perception as a vehicle for social change’, Social Issues and Policy Review, 10(1): 181211.
Thaler, R. H. and Sunstein, C. (2009), Nudge: Improving Decisions About Health, Wealth, and Loss Aversion, London: Penguin.
Tuohy, C. H. (1999), Accidental logics: The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada, Oxford: Oxford University Press.
Wenger, E., McDermott, R. A. and Snyder, W. (2002), Cultivating Communities of Practice: A Guide to Managing Knowledge, Boston: Harvard Business Press.
Wilson, D. S. (2015), Does Altruism Exist?: Culture, Genes, and the Welfare of Others, London: Yale University Press.
Wilson, J. Q. and Kelling, G. L. (1982), ‘Broken Windows’, in R. G. Dunham and G. P. Alpert (eds), Critical Issues in Policing: Contemporary Readings Long Grove, IL: Waveland Press, Inc., 395–407.
World Health Organization (WHO), UNICEF, UNFPA, World Bank Group and the United Nations Population Division (2015), ‘Trends in Maternal Mortality: 1990 to 2015: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division’, WHO, Geneva, p. 77.

Reputations count: why benchmarking performance is improving health care across the world

  • Gwyn Bevan (a1), Alice Evans (a2) and Sabina Nuti (a3)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed