Performance management within the NHS

A performance measurement (PM) system should exemplify an organisation’s activities, so it can learn and adapt based on its assessment (Otley, 1999; Adler, 2011; Agostino & Arnaboldi, 2012). This paper investigates ‘to what extent NHS performance can be measured’ in the confines of the Accident and Emergency (A&E) department, at East Lancashire Hospitals NHS Trust. The NHS constitution stipulates ‘95% of patients should be seen and discharged within 4-hours’; hence, this is widely regarded as the ‘key metric’ of AE NHS England, 2013). Since 2013, performance across all areas of health and social care in England, is externally regulated by the Care Quality Commission (CQC, 2015). In 2015/16 ELHT’s emergency services treated over 185,000 patients, placing it in the top-twenty busiest units in the country. Unfortunately, its 4-hour target for the same period was 92.5% and its emergency services were classified as ‘requiring improvement’ by the CQC (HSCIC, 2016; CQC, 2014). Literature relating to performance was critically reviewed, alongside theories of organisational effectiveness (OE). The CQC’s performance regulatory framework was appraised against theoretical models and considered to support PM from an ‘internal process’ perspective (of OE). Conversely, A&E was deemed to align with an ‘open systems’ model i.e. its individuals, groups, processes and interactions are interconnected with the rest of the hospital and the external environment (Stacey & Mowles, 2016). After evaluating various models of ‘open systems’, key components of A&E performance were aggregated and conceptualised into an appropriate framework. Subsequently, research was undertaken in the practical setting to identify areas for improvement. A critical realist research philosophy was applied to a case study design, which incorporated self-completion questionnaires, semi-structured interviews and secondary data collection methods. Research identified some good practices, particularly in relation to A&E’s internal processes i.e. policies and procedures. Other areas included improvements in competency training and medical device technologies. Staff’s professionalism and sense of purpose to providing exceptional care was also very strong. This mood was offset by a sense of disengagement from the organisation that echoed through the factors of the conceptual framework, leading to the following recommendations: r einforce vision and values to AE create a bespoke AE review AE budget training for senior AE r oll-out of e-Rostering training; u pdate of job descriptions against workplace demands; review of appraisal process; upgrade of IT systems. An area for further research was uncovered relating to producing a standardised ‘A&E coefficient’, which captures all elements of open systems performance, allowing fair comparison for A&E departments across the country.