Measures of Performance

Since the publication of the initial American College of Cardiology (ACC)/American Heart Association (AHA) Methodology for the Selection and Creation of Performance Measures,1 there has been an explosion in the development and application of performance measures. Although initially envisioned as a means for physician-led quality-improvement efforts, performance measures have been primarily used as tools for accountability and performance-based reimbursement instead. Given the centrality of and experience with performance measures for quantifying healthcare quality, the American College of Cardiology Foundation (ACCF)/AHA Task Force on Performance Measures sought to update its methodology so that ongoing efforts to measure performance could benefit from emerging insights. The original methodology, proposed in 2005,1 remains the foundation for developing process performance measures. The principal recommendations of the 2005 report are summarized in Table 1. The 2010 report does not address detailed issues of analysis,3 pay for performance,4 or nonfinancial rewards for better performance5 because these topics have been addressed in other statements. The focus of the 2010 report is to provide a state-of-the-art perspective on the construction, collection, and emerging directions of performance measurement as a means to improve healthcare quality. View this table: Table 1. ACCF/AHA Attributes of Performance Measures Figure 1. An overview of the steps in providing care by domain. Reprinted from Spertus et al.1 Performance measures that articulate discrete processes of care, as opposed to structural aspects of care or outcomes, are distinctly different from both clinical practice guidelines and appropriate use criteria because they represent a subset of the clinical guidelines for which the evidence is sufficiently strong: typically where the highest-quality evidence of benefit unequivocally exceeds risk (Class I recommendation, Level of Evidence: A),8 failure to provide the therapy to an eligible patient meaningfully reduces the likelihood that the patient will experience the best possible outcome. In this report, …

This study examines the links between financial performance and executive compensation for high-performance companies (HPC). HPC display sustained and superior cash flow returns, asset growth, and total shareholder returns. In previous empirical analysis, HPC companies displayed specific identifiable financial performance drivers and measures when compared to companies in the S&P 500 (Needles et al., 2004). Most recently, HPC sustained their high performance when compared to the S&P 500 over varied economic periods. Further, the research identified operating asset management characteristics of these companies, especially as they relate to the cash cycle (Needles et al., 2004). Continuing this stream of research, this study first identifies the financial and non-financial performance measures related to compensation of top management of HPC as reported in the companies’ public disclosures. Then, these findings for HPC are matched to a set of comparable non-HPC. Finally, we evaluate the stated performance measures for executive compensation in light of the performance drivers and measures identified by previous research to be distinguishing characteristics of HPC. We hypothesize that HPC will more closely align stated performance measures for executive compensation with performance characteristics that have been shown to be characteristics of HPC. We find that HPC are more focused and unambiguous in their use of both financial and non-financial performance measures in executive compensation.

Effect of Compliance to Updated AHA/ACC Performance and Quality Measures Among Patients With Atrial Fibrillation on Outcome (from Japanese Multicenter Registry)

PurposeThe purpose of this paper is to examine the relative and incremental information content of a cash recovery‐based measure of performance, the estimated internal rate of return, vs an earnings‐based measure of performance, return on assets, in explaining firms' economic performance.Design/methodology/approachThe paper uses the cash recovery rate that is based on continuous time analysis and U‐shaped cash flows to derive the estimated internal rate of return and compare it to return on assets. A cross‐sectional sample was used over a short interval (year 1993 and year 2005) and a time‐series sample (1993‐2005) to empirically examine the relative and incremental information content of the competing measures. Tobin's q and stock returns are used as performance benchmarks.FindingsThe results of the empirical tests indicate that the estimated internal rate of return provides better relative and incremental information content over earnings‐based measures of performance. Specifically, the empirical evidence shows that the estimated internal rate of return is consistently positively related to Tobin's q and stock returns over all measurement intervals.Research limitations/implicationsThese results imply that earnings‐based performance measures are less value relevant compared to cash recovery‐based measures. There are some limitations that may apply to this study. First, the systematic measurement error in estimating the cash recovery rate may not be independent of the measurement error in the estimated internal rate of return. Second, the performance benchmarks used in the study are not free from problems. Particularly, the return on assets is influenced by firms' rate of growth and the Tobin's q is not a perfect measure of business performance. Therefore, one avenue of future research is to assess the usefulness of financial accounting data for analysts forecast. Moreover, future research may also examine the role of institutional changes in financial reporting and its effect on the quality of earnings and economic performance.Originality/valueThis paper presents extended research on cash recovery‐based vs earnings‐based metrics as proxies for economic return using improved research designs, larger samples and new sensitivity analyses.

Diabetes mellitus performance measures in individuals with limited life expectancy.

Background: Oral contraceptives are commonly used by women athletes. However, their effect on athletic performance is unclear. Objectives: To examine the effects of a moderate dose, triphasic oral contraceptive on...

Purpose– The purpose of this paper is to understand the effect of gender diversity on firm performance and evaluate how that relationship is influenced by some firm-specific factors for firms in an emerging market.Design/methodology/approach– The authors collected firm level financial data and firm level characteristics for the firms listed in BIST100 index of Borsa Istanbul for the period between 2002 and 2006. Due to endogeneity of gender diversity and firm performance, the authors utilize unbalanced panel data with 2SLS specification. To observe the sensitivity of results across measures of performance, three measures of performance, two accounting-based and one market-based, are utilized.Findings– Overall, the authors find some weak evidence that gender diversity impacts firm performance. In particular, the findings imply significant association between gender diversity and firm performance for firms that are targeting local markets, for firms in the financial sector and for firms that are family or block-owned. Moreover, findings are fragile with respect to the measures of diversity and performance selected.Originality/value– Although the relationship between gender diversity and firm performance are investigated several times in the past, there are not many studies that examines the role of firm-specific factors on that relationship. By revealing the factors that are important, this study provides an explanation why the existing literature leads to mixed results.

Functional brain connectivity and cognition: effects of adult age and task demands

This research explores how child protection is constructed through performance measurement, and how the selection and reporting of performance indicators influences policy and practice. Performance measurement is now a mainstay of public sector management. At one level, it has a role in addressing ever-present questions about the quality and effectiveness of child protection services. However, there are concerns about assessing performance within a management framework, rather than a professional or client-centred framework. Therefore, the thesis aims to critically engage with the problems and potential of performance measurement in child protection with a view to maximising its capacity to promote better outcomes for children and families. It focuses particularly on the role of family support, because despite its proclaimed importance in legislation and policy, in practice family support work remains marginalised, situated 'outside' core child protection work. The research approaches performance measurement from a critical policy perspective, in which indicators have both technical and policy functions. While performance measurement may be viewed rationally as a means for government to manage resources, from a broader policy perspective the way it is conceptualised and implemented has major consequences for service delivery. The policy significance of performance measurement is explored through two studies. The first study analyses developments in policy and practice in three jurisdictions: England, Victoria (Australia) and Queensland (Australia). This analysis contrasts the prominent position of family support in child protection legislation and policy, with its marginal position in both practice and performance measurement. It outlines the socio-political context for performance measurement in child protection, drawing out the values and power relations embedded in performance indicators that give them a role in communicating policy intent. The study concludes that performance measurement in all three jurisdictions is directing policy attention (and therefore resources) towards investigation and out-of-home care, largely ignoring family support. The second study moves beyond the policy critique to more concrete concerns about how to reconstruct performance measurement in child protection to encompass family support indicators. Using a survey method, it seeks to describe and analyse the practice of family support in one jurisdiction (Queensland) according to a performance measurement model of inputs, outputs, processes and outcomes. It concludes that useful performance data can be collected to aid understanding of the contribution of family support to the overall child protection system. Such data will help to move family support beyond assumptions about its value, towards empirical scrutiny of its methods and results. It suggests that family support will command greater policy attention if included in the child protection performance measurement effort. The thesis concludes that viewed from a critical policy perspective, performance measurement can be harnessed in the interests of good practice. It can assist with the repositioning of family support, moving it from the realm of unproblematic moral goodness to more critical inquiry. It argues there is nothing inherently wrong with measuring effectiveness and efficiency, but it is important to examine the manner in which performance measurement is developed and implemented, its methods and consequences. Performance indicators are not neutral or merely technical. Establishing indicators can influence how social problems such as child abuse and neglect are defined, where resources are placed, what service types are funded, and how outcomes for children and families are defined. It questions the privilege performance indicators may be given within managerial approaches to government, as if they somehow provide an objective and unbiased account of how services are performing. However, this is not to suggest that performance indicators are worthless or meaninglessmrather that their meaning should be explicit, and their underpinning value stances debated within policy processes. Such debate will enhance the congruency between child protection research and indicators, and democratise the processes by which performance measures are developed, used and reported.

A number of different performance measures have been used in the design and analysis of material handling systems. These performance measures have measured either: (1) the entire manufacturing system (e.g. job throughput), or (2) the material handling system independently (e.g. vehicle travel distance). The following is a review of performance, reliability, and performability measures used in the analysis and design of material handling systems in a manufacturing environment.

PurposeThe intent of microfinance institutes (MFIs) in developing countries is to provide loans to very poor people in order to help them transform their lives. MFIs tend to receive subsidies; sustainability is being sought to free MFIs from non‐market dependencies. Sustainability is expected to be achieved with “best practices,” of which management with performance measures is a component. The purpose of this paper is to examine the use of performance measures by three Kenyan MFIs, which are classified as formal and client based, and likely to use rational and explicit performance measures. Clients in these MFIs are placed into self‐help groups with two responsibilities: to provide mutual support and advice to the borrowing client; and to provide the MFI with a guarantee that loans of group members will be repaid.Design/methodology/approachBased on a review of the economics and performance measurement systems literatures, research questions were developed along with an interview guide. Case studies were used to administer an interview guide which was distributed to the respondents prior to the face‐to‐face interviews.FindingsThe study concludes that MFIs have relatively well‐developed performance measures that support their particular businesses. There was a good balance between the use of financial and non‐financial performance measures. However, output measures were more commonly used than process measures. The nature of the MFIs suggests the importance of performance measurement. The managers of the MFIs are concerned with performance measurement, as expected within a bureaucracy, and a top‐down demand is present. In addition, group members or clients are interested in performance measurement as each member guarantees the loans of all fellow group members who have loans with the MFI. Thus, the customers exert a bottom‐up demand for performance measurement.Originality/valueThe findings support the view that performance measures are a means for managing MFIs and are a likely requirement for sustainability. Furthermore, the findings have identified performance measures (similar to those at banks) that are appropriate for the three MFIs in Kenya. The findings are important since the identified performance measures may be adopted by other evolving MFIs in this relatively new sector. In addition, the findings contribute to a better understanding of the genesis of the less popular results and determinants performance measurement framework of Fitzgerald et al.

Performance measurement has been part of the lexicon of public administration in the United States for several decades, but rhetoric has outdistanced practice by far in this area. Currently, however, there is a renewed interest in performance measures as an essential element of the results-oriented management movement that is sweeping the field, as reflected in legislative mandates and administrative initiatives as well as considerable conference and training activity and a revived stream of books and articles on the subject. Nevertheless, the extent to which performance measurement has taken hold in a meaningful way in public agencies is still an open question, particularly with respect to local government. Based on a survey of U.S. cities with populations of 25,000 and over, this article explores the extent to which performance measures are used and how they are used in contemporary municipal government. The Quest For Performance Measurement Performance measurement is an old idea that has taken on renewed importance. Measuring workload and worker efficiency was clearly part of the scientific management approach at the turn of the century, and the International City Management Association produced a publication on measuring municipal activities as early as 1943 (Ridley and Simon, 1943). In more modern times concern for measuring the performance of public programmatic entities arose with the interest in program budgeting in the 1960s and program evaluation in the 1970s. Harry Hatry and colleagues at the Urban Institute began publishing materials that promoted the use of performance measures and provided instruction on how to develop and use them (Hatry and Fisk, 1971; Waller, et al., 1976; Hatry, et al., 1977), while other authors talked about how to incorporate them in larger management processes (Altman, 1979; Epstein, 1984; Steiss, 1985; Wholey, 1983). A related but different stream of articles focused on performance measures as they play into the budgeting process (Grizzle, 1985; 1987; Brown and Pyers, 1988). Yet it has generally been understood that the promise and potential of performance measures greatly exceed their actual usefulness in practice. Indeed, one of the underlying premises of Downs and Larkey's The Search for Government Efficiency (1986) was that for a variety of reasons most governmental jurisdictions did not have the capability of measuring the performance of their programs. Performance Measurement in an Era of Public Management Reform A number of forces in the field of public administration have led to a renewed, or reinvigorated, interest in performance measurement in the 1990s. Taxpayer revolts, pressure for the privatization of public services, legislative initiatives aimed at controlling runaway spending, and the devolution of many responsibilities to lower levels of government have generated increased demands to hold government agencies accountable to legislatures and the public in terms of what they spend and the results they produce. In addition, the reinventing government movement initiated by Osborne and Gaebler in 1992 and Vice President Al Gore's National Performance Review in 1993 have called for a new way of thinking about how public agency performance is defined and measured. Driven in part by these external pressures and in part by their own motivation to provide cost-effective public services, public managers have been using a variety of approaches to strengthen the management capacity of their organizations, most notably through strategic planning (Bryson, 1995; Berry and Wechsler, 1995), through more encompassing strategic management processes (Eadie, 1989; Koteen, 1991; Vinzant and Vinzant, 1996), through quality management programs and reengineering processes (Berman and West, 1995; Cohen and Brand, 1993; Davenport, 1994; Hyde, 1995; Kravchuck and Leighton, 1993), and through benchmarking practices (Bruder, 1994; Keehley, et al. 1997), as well as reformed budgeting processes (Joyce, 1993; Lee, 1997). …

Patient safety is influenced by the frequency and seriousness of errors that occur in the health care system. Error rates in laboratory practices are collected routinely for a variety of performance measures in all clinical pathology laboratories in the United States, but a list of critical performance measures has not yet been recommended. The most extensive databases describing error rates in pathology were developed and are maintained by the College of American Pathologists (CAP). These databases include the CAP's Q-Probes and Q-Tracks programs, which provide information on error rates from more than 130 interlaboratory studies. To define critical performance measures in laboratory medicine, describe error rates of these measures, and provide suggestions to decrease these errors, thereby ultimately improving patient safety. A review of experiences from Q-Probes and Q-Tracks studies supplemented with other studies cited in the literature. Q-Probes studies are carried out as time-limited studies lasting 1 to 4 months and have been conducted since 1989. In contrast, Q-Tracks investigations are ongoing studies performed on a yearly basis and have been conducted only since 1998. Participants from institutions throughout the world simultaneously conducted these studies according to specified scientific designs. The CAP has collected and summarized data for participants about these performance measures, including the significance of errors, the magnitude of error rates, tactics for error reduction, and willingness to implement each of these performance measures. A list of recommended performance measures, the frequency of errors when these performance measures were studied, and suggestions to improve patient safety by reducing these errors. Error rates for preanalytic and postanalytic performance measures were higher than for analytic measures. Eight performance measures were identified, including customer satisfaction, test turnaround times, patient identification, specimen acceptability, proficiency testing, critical value reporting, blood product wastage, and blood culture contamination. Error rate benchmarks for these performance measures were cited and recommendations for improving patient safety presented. Not only has each of the 8 performance measures proven practical, useful, and important for patient care, taken together, they also fulfill regulatory requirements. All laboratories should consider implementing these performance measures and standardizing their own scientific designs, data analysis, and error reduction strategies according to findings from these published studies.

Cost-effectiveness analysis in cardiac surgery: A review of its concepts and methodologies

Performance measures were necessary to obtain a complete picture of osteoarthritic patients