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Hitting and missing targets by ambulance services for emergency calls: effects of different systems of performance measurement within the UK.

Bevan G, Hamblin R - J R Stat Soc Ser A Stat Soc (2009)

Bottom Line: In other countries, the target has been missed by such large margins that services would have been publicly reported as failing, if they had been covered by the English system of star ratings.The paper argues that this case-study adds to evidence from comparisons of different systems of hospital performance measurement that, to have an effect, these systems need to be designed to inflict reputational damage on those that have performed poorly; and it explores implications of this hypothesis.The paper also asks questions about the adequacy of systems of performance measurement of ambulance services in UK countries.

View Article: PubMed Central - PubMed

ABSTRACT
Following devolution, differences developed between UK countries in systems of measuring performance against a common target that ambulance services ought to respond to 75% of calls for what may be immediately life threatening emergencies (category A calls) within 8 minutes. Only in England was this target integral to a ranking system of 'star rating', which inflicted reputational damage on services that failed to hit targets, and only in England has this target been met. In other countries, the target has been missed by such large margins that services would have been publicly reported as failing, if they had been covered by the English system of star ratings. The paper argues that this case-study adds to evidence from comparisons of different systems of hospital performance measurement that, to have an effect, these systems need to be designed to inflict reputational damage on those that have performed poorly; and it explores implications of this hypothesis. The paper also asks questions about the adequacy of systems of performance measurement of ambulance services in UK countries.

No MeSH data available.


Related in: MedlinePlus

Percentage of category A calls met within 8 minutes, in England (▪), Wales (•) and Scotland (Δ) (sources: England, Department of Health (1999a, 2000, 2001) (for 1999–2001) and Information Centre (2007) (for 2002–2007); Wales, National Assembly for Wales (2005) (for 2000–2004), Auditor General for Wales (2006), page 37 (for 2005 and 2006), and Welsh Assembly Government (2007b) (for 2007); Scotland, Auditor General for Wales (2006), page 37, and Audit Scotland (2007), page 2 (for 2007))
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fig02: Percentage of category A calls met within 8 minutes, in England (▪), Wales (•) and Scotland (Δ) (sources: England, Department of Health (1999a, 2000, 2001) (for 1999–2001) and Information Centre (2007) (for 2002–2007); Wales, National Assembly for Wales (2005) (for 2000–2004), Auditor General for Wales (2006), page 37 (for 2005 and 2006), and Welsh Assembly Government (2007b) (for 2007); Scotland, Auditor General for Wales (2006), page 37, and Audit Scotland (2007), page 2 (for 2007))

Mentions: Fig. 2 gives performance (where data are available) for England, Wales and Scotland, from 1999–2000 to 2005–2006. This shows that the service in England achieved the 75% target on average from 2003 (the reduction in 2006 is due to an adjustment to reflect concerns about data recording in six English trusts—this is discussed below). The service in Wales, which has achieved neither the 75% target set in 2001, nor the 65% target set in 2004 nor the 60% target set in 2005, was the subject of a damning report by the Auditor General for Wales (2006) (see below). Fig. 2 shows that, since 2004, the ambulance service in Scotland had a similar performance to that of Wales, meeting less than 60% of category A calls within 8 minutes. The only information that we have been able to find on the performance of the service in Northern Ireland was that, in 2005–2006, this met 51% of category A calls within 8 minutes (Rooker, 2006). These standards of performance seem to have had little resonance in either Scotland or Northern Ireland.


Hitting and missing targets by ambulance services for emergency calls: effects of different systems of performance measurement within the UK.

Bevan G, Hamblin R - J R Stat Soc Ser A Stat Soc (2009)

Percentage of category A calls met within 8 minutes, in England (▪), Wales (•) and Scotland (Δ) (sources: England, Department of Health (1999a, 2000, 2001) (for 1999–2001) and Information Centre (2007) (for 2002–2007); Wales, National Assembly for Wales (2005) (for 2000–2004), Auditor General for Wales (2006), page 37 (for 2005 and 2006), and Welsh Assembly Government (2007b) (for 2007); Scotland, Auditor General for Wales (2006), page 37, and Audit Scotland (2007), page 2 (for 2007))
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2667302&req=5

fig02: Percentage of category A calls met within 8 minutes, in England (▪), Wales (•) and Scotland (Δ) (sources: England, Department of Health (1999a, 2000, 2001) (for 1999–2001) and Information Centre (2007) (for 2002–2007); Wales, National Assembly for Wales (2005) (for 2000–2004), Auditor General for Wales (2006), page 37 (for 2005 and 2006), and Welsh Assembly Government (2007b) (for 2007); Scotland, Auditor General for Wales (2006), page 37, and Audit Scotland (2007), page 2 (for 2007))
Mentions: Fig. 2 gives performance (where data are available) for England, Wales and Scotland, from 1999–2000 to 2005–2006. This shows that the service in England achieved the 75% target on average from 2003 (the reduction in 2006 is due to an adjustment to reflect concerns about data recording in six English trusts—this is discussed below). The service in Wales, which has achieved neither the 75% target set in 2001, nor the 65% target set in 2004 nor the 60% target set in 2005, was the subject of a damning report by the Auditor General for Wales (2006) (see below). Fig. 2 shows that, since 2004, the ambulance service in Scotland had a similar performance to that of Wales, meeting less than 60% of category A calls within 8 minutes. The only information that we have been able to find on the performance of the service in Northern Ireland was that, in 2005–2006, this met 51% of category A calls within 8 minutes (Rooker, 2006). These standards of performance seem to have had little resonance in either Scotland or Northern Ireland.

Bottom Line: In other countries, the target has been missed by such large margins that services would have been publicly reported as failing, if they had been covered by the English system of star ratings.The paper argues that this case-study adds to evidence from comparisons of different systems of hospital performance measurement that, to have an effect, these systems need to be designed to inflict reputational damage on those that have performed poorly; and it explores implications of this hypothesis.The paper also asks questions about the adequacy of systems of performance measurement of ambulance services in UK countries.

View Article: PubMed Central - PubMed

ABSTRACT
Following devolution, differences developed between UK countries in systems of measuring performance against a common target that ambulance services ought to respond to 75% of calls for what may be immediately life threatening emergencies (category A calls) within 8 minutes. Only in England was this target integral to a ranking system of 'star rating', which inflicted reputational damage on services that failed to hit targets, and only in England has this target been met. In other countries, the target has been missed by such large margins that services would have been publicly reported as failing, if they had been covered by the English system of star ratings. The paper argues that this case-study adds to evidence from comparisons of different systems of hospital performance measurement that, to have an effect, these systems need to be designed to inflict reputational damage on those that have performed poorly; and it explores implications of this hypothesis. The paper also asks questions about the adequacy of systems of performance measurement of ambulance services in UK countries.

No MeSH data available.


Related in: MedlinePlus