National Performance Framework Research Articles

PERFORMANCE BUDGETING IN THE SOUTH-EAST EUROPE COUNTRIES: A COMPARATIVE STUDY ON PRESENT STATE AND FUTURE PERSPECTIVES

Adoption of any budget is perhaps the most important and time-consuming activity of any government. As a modern tool for linking strategic planning and budgeting, performance budgeting is conditio sine qua non for implementation of modern multi-annual budgeting system. Performance budgeting was first introduced in the United States and today different models are used in practice. The aim of this research is to investigate the state of implementation of performance budgeting reform(s) in the South East Europe (SEE) countries, namely Albania, Kosovo, Montenegro, North Macedonia, Serbia, Bosnia and Herzegovina, Bulgaria, Croatia, Moldova, Romania, Greece, Slovenia, and Turkey and their struggle to implement performance budgeting reform. The United States, Australia and the European Union are the examples of developed countries implementing performance-based budgeting and their experience can be helpful to SEE countries in their efforts to establish working performance budgeting system. In this research, the focus is on answering questions about presence and elements of national performance framework, UN Sustainable Development Goals, performance budgeting framework and characteristics, and authority for the design and implementation of performance budgeting system. Based on the research results, the authors provide recommendations for better implementation of performance budgeting in selected countries.

Towards Countries that Care; Advocating A new National Outcome on care for the National Performance Framework in Scotland

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Social wellbeing in Scotland – the ‘career network’ of a policy concept

Scotland presents a case where ‘social wellbeing’ as a policy concept and a societal aspiration has had considerable traction over the past decade. Wellbeing is now, according to Scotland’s outcomes-based National Performance Framework, at the centre of local and national policy-making. This article, by employing the analytical lens of governance networks, discusses how wellbeing has become such a prominent policy concept in Scotland. The article first maps the development of the concept through an analysis of the actors which make up the ‘wellbeing coalition’ and then discusses the role that these different actors played. Interviews and published documents form the basis for the analysis and also feed into software-supported social network analysis.The analysis shows that the Scottish Government is taking a central position in a fairly extensive wellbeing network composed almost exclusively of public and third sector organisations, with a very limited number of organisations being particularly prominent over the past decade. Contrary to expectations, the Scottish media took relatively little interest in the ‘wellbeing debate’, and academics played only a very minor role. It also highlights how a number of concurrent domestic and international political developments contributed to putting wellbeing on the agenda in Scotland, in particular the Global Financial Crisis and the subsequent recession.

Would program performance indicators and a nationally coordinated response accelerate the elimination of tuberculosis in Canada?

Twenty years ago, a National Consensus Conference on Tuberculosis (TB) recommended that the provinces and territories of Canada jointly declare a commitment to TB elimination with national coordination and assured funding, executed by a committee of federal and provincial/territorial representatives. Canada has committed to the global TB elimination targets set forth by the World Health Organization but lacks a coordinated response. In particular, with the exception of one published and implemented by Indigenous Services Canada, there has been no national monitoring and performance framework. Herein, we provide a commentary on the importance, to TB elimination in Canada, of developing such a framework. We invite a debate about whether more can and should be done to monitor and report for action at every jurisdictional level. Of utmost importance will be the need to achieve consensus from stakeholders about what is measured, among whom, how often, who collects and processes data, and how to respond to the successes and failures those data indicate. Insofar, as performance targets are well defined and implemented, national progress towards tuberculosis elimination should accelerate.

Mutual Learning about Health System Performance in Australia's Intergovernmental Health Committee System?

Since the early 1990s Australia, through the Australian Health Minister’s Advisory Council, began the process of developing a national health system performance framework. This includes service delivery measures for hospitals and has been used as a template for national data collections in mental health services. National performance frameworks have since become part of promoting greater integration of policy making and service delivery across Commonwealth and State jurisdictional health functions. The key focus of this paper is upon inter-governmental processes and routines to develop Australian national performance regimes in the realms of health and mental health care services. It presents initial findings from 26 elite interviews working across the inter-governmental interface, including some data about experiences of service managers. The report provides two contributions to the existing literature on Australia’s federal health system and more specifically health governance. Firstly, it presents a literature review of studies and theoretical concepts that have been deployed to examine cross jurisdictional processes of decision making. There is particular attention for the European literature on inter-governmental committee systems. Secondly, the paper presents initial findings from an explorative study of Australia’s inter-governmental machinery in the realms of health and mental health care services. This explorative study was based upon an initial 26 elite interviews from respondents working (or having worked in) Australia’s inter-governmental machinery, including some respondents from representatives of relevant Commonwealth semi-autonomous bodies. The researcher also observed two inter-governmental committee proceedings although reported data here draws only from interviews. These findings provide a first insight into the inner workings of Australia’s inter-governmental health machinery. It is argued that there has been evidence of mutual learning from Australia’s National Health Performance initiatives, and, exchanges and recommendations for future research to further investigate and pinpoint the causal processes through which mutual learning occurs are provided.

Use of public health science to inform Scotland's National Parenting Strategy: an outcomes framework approach

BackgroundA shift to an outcomes approach in Scotland has been triggered by the creation of the National Performance Framework (NPF). The aim of the NPF is to focus public reporting on progress towards achieving national outcomes. The Scottish Government tasked NHS Health Scotland with supporting this shift. One type of support has been to provide resources (outcomes frameworks) that help planners link local activities with the NPF. NHS Health Scotland has recently led the development of an outcomes framework for Scotland's National Parenting Strategy in collaboration with a wide range of partners. The aim of the framework is to identify the key outcomes for Scotland's National Parenting Strategy; specify those local activities that might be undertaken to achieve these shared outcomes; understand the contribution of partnership activities to delivering outcomes; and bring together and summarise the existing relevant evidence for effective interventions to support parents and families. We present an overview of the framework and the evidence contribution to its development. MethodsThree logic models underpin the outcomes framework. Two nested models—interventions to support parents, families, and society; and structures and systems—flow into a strategic model. Together, these models set out the actions, reach, and outcomes for the strategy and its contribution to other national outcomes. In turn, these models were informed by a series of evidence reviews carried out by NHS Health Scotland and the Scottish Collaboration for Public Health Research and Policy. FindingsThe evidence reviews established the best available evidence for effective interventions to support parents and families. They covered interventions for parents of infants and children in the early years; interventions for parents of older children and adolescents; and characteristics of effective and ineffective adolescent health interventions with a parental component. These reviews were used to develop the rationale for national and local activities in supporting the identified key outcomes. InterpretationOutcomes frameworks like that for Scotland's National Parenting Strategy can help implementation of public health science into both national policy and local practice. FundingNone.

Enhancing China's Innovation Performance: The Policy Choices

AbstractTransforming China into an innovation‐driven economy has been one of the top priorities of the Chinese Government. This paper examines the policy choices involved in the extended national innovation performance framework for creating an open innovation system. Innovation capabilities, incentives and institutional frameworks are examined. The paper argues that China should continue to increase its investment in R&D and in education, and that there should also be an attempt to strengthen the incentive system at the macro, meso and micro levels. This strengthening may include reforms to: release the power of competition and guide resources towards innovative sectors; adopt appropriate human resource management, such as appraisal and remuneration systems; create effective policies for research funding management; and evaluate the efficiency of research to encourage the creativity of researchers, managers and employees. The paper also discusses the space for industrial policy in the 21st century.

Mapping Socio-Economic Performance in Rural Scotland

Scottish Neighbourhood Statistics (SNS) is a unique data set that provides information for each of more than 6500 geo-referenced data zones within Scotland. Based on SNS data, this paper develops a multi-component indicator of socio-economic performance which may aid the Scottish Government in assessing, within its National Performance Framework, the well-being of its citizens in rural areas. The results show generally but not universally high correlations between the components of the indicator, and marked spatial variation of the indicator itself. High-performing areas include the hinterlands of some but not all Scottish cities, and some relatively remote areas, while the relatively poorly performing data zones are found in most but not all of the more remote rural regions. When updated with 2011 data, the performance indicator could aid in formulating more targeted policies aimed at addressing differences – e.g. in well-being – between rural areas.

Valuing Geodiversity and Geoconservation: Developing a More Strategic Ecosystem Approach

This paper reviews the values and benefits of geodiversity and geoconservation in the context of the Strategic Objectives and National Outcomes in the Scottish Government's National Performance Framework, particularly in relation to: economic development; climate change adaptation; biodiversity; science and education; and recreation, health and cultural inspiration. A key challenge is to improve the integration of geodiversity in environmental policy and its implementation in order to deliver more holistic and sustainable environmental management and wider public benefits. This requires greater awareness and recognition of the key benefits and ecosystem services that geodiversity provides for society. With an overall objective of promoting integration of geodiversity into relevant policies and decision frameworks, we advocate a more strategic, ecosystem-based approach to address: the future-proofing of ecosystem services, particularly in a context of climate change and rising sea-levels; conservation and sustainable management of geodiversity both in designated sites and in the wider countryside; raising awareness of the value of geodiversity and its contribution to ecosystem services; and improving understanding of geodiversity and key knowledge gaps. Such an approach is adopted in the Scotland's Geodiversity Charter.

Culture and the Scottish Household Survey

In 2007 the Scottish Government introduced an outcomes based approach to culture set within a National Performance Framework. One of the main data sources to measure “culture” in Scotland is the Scottish Household Survey (SHS). In this article, the SHS and its “Culture and Sport” Module are explored to show how useful the data is within the Scottish Government's economic agenda. This way, the paper reflects on the usefulness of the main data source used to understand cultural activity within Scotland. There are general difficulties measuring “culture”, but overall the SHS provides adequate national data for Scotland on cultural participation and attendance. However, the SHS cannot provide in-depth local level information and provides limited data on non-participants. Other surveys in Scotland and England give some example practices that could be incorporated to improve survey outcomes. Overall, the SHS is a useful policy tool but more could be done to utilise the data it can provide on the Scottish cultural sector.

Development of clinical‐quality registries in Australia: the way forward

Australia is developing a national performance framework aimed at measuring health outcomes across the health system.

Review of Scottish Arts Council's Quality Framework – guidelines for arts organisations (2nd ed.), 2009

The Scottish Arts Council's “Quality Framework” was launched in 2007 as a continuous improvement toolkit. It provides a flexible framework for arts organizations to evaluate the impact of funding decisions. Developing tools that allow organizations to demonstrate their impact provides robust information to further build the evidence base for the cultural sector. The second edition (2009) has been revised after evaluation and consultation with arts organizations and Scottish Arts Council staff. Taking this approach and gathering further evidence is an important step in the lead up to Creative Scotland (which is the newly established creative arts funding body within Scotland). Continuous improvement tools not only gather evidence but can improve work practices. The Quality Framework should be viewed in the context of the National Performance Framework, as gathering outcome evidence will also assist in the production of Local Authority Single Outcome Agreements. This review also looks at the Unified Quality Improvement Framework, an over-arching tool that will assist local authorities and other service providers to evaluate the quality of their culture and sport provision. Evidencing sector information such as arts activity will be an important part of this process. The Quality Framework is a tool to gather outcome-based evidence that will show how culture can contribute to a variety of policy objectives.

Development of clinical‐quality registries in Australia: the way forward

Australia is developing a national performance framework aimed at measuring health outcomes across the health system. Clinical registries provide a clinically credible means of monitoring health care processes and outcomes, yet only five Australian registries currently have national coverage. At a national level, clinical registry development should be prioritised to target conditions or procedures that are suspected of being associated with large variations in processes or outcomes of care and that impact significantly on health care costs and patient morbidity. Registries should also aim to capture information across care interfaces and to monitor the medium and long-term safety and effectiveness of specific devices, procedures and drugs.

The economics of primary healthcare reform in Australia – towards single fundholding through development of primary care organisations

A strong primary care sector is widely acknowledged as a fundamental component of a well functioning health system and thus has been the focus of strategic reforms in a number of countries. This paper provides an economic analysis of primary healthcare reform, with the aim of identifying the key structural elements that are necessary to support enhanced models of primary health in the Australian context. This paper utilises economic theory, and draws upon empirical evidence and international experience to analyse primary healthcare reform to identify the structural elements necessary for an enhanced primary care sector. The aim of which is to improve health system performance. These structural elements are then critically examined in the Australian health system setting. For enhanced models of primary healthcare to promote efficiency, they must incorporate a number of key structural elements; notably: governance and purchasing responsibilities for primary care devolved to a meso-level organisational structure through capitated single fundholding arrangements; blended payment methods for reimbursing providers; the establishment of a national quality and performance framework; and the development of primary care infrastructure. As the Federal government attempts to address recommendations of the National Health and Hospital Reform Commission, a window of opportunity now exists to pursue long overdue structural reforms to deal with the challenges facing the Australian health system. The paper advances the important structural features to primary healthcare that need to be embraced as the government attempts to pursue its health reform agenda.

The Royal Australian and New Zealand College of Radiologists (RANZCR) relative value unit workload model, its limitations and the evolution to a safety, quality and performance framework

The study reports on the evolution of the Australian radiologist relative value unit (RVU) model of measuring radiologist reporting workloads in teaching hospital departments, and aims to outline a way forward for the development of a broad national safety, quality and performance framework that enables value mapping, measurement and benchmarking. The Radiology International Benchmarking Project of Queensland Health provided a suitable high-level national forum where the existing Pitman-Jones RVU model was applied to contemporaneous data, and its shortcomings and potential avenues for future development were analysed. Application of the Pitman-Jones model to Queensland data and also a Victorian benchmark showed that the original recommendation of 40,000 crude RVU per full-time equivalent consultant radiologist (97-98 baseline level) has risen only moderately, to now lie around 45,000 crude RVU/full-time equivalent. Notwithstanding this, the model has a number of weaknesses and is becoming outdated, as it cannot capture newer time-consuming examinations particularly in CT. A significant re-evaluation of the value of medical imaging is required, and is now occurring. We must rethink how we measure, benchmark, display and continually improve medical imaging safety, quality and performance, throughout the imaging care cycle and beyond. It will be necessary to ensure alignment with patient needs, as well as clinical and organisational objectives. Clear recommendations for the development of an updated national reporting workload RVU system are available, and an opportunity now exists for developing a much broader national model. A more sophisticated and balanced multidimensional safety, quality and performance framework that enables measurement and benchmarking of all important elements of health-care service is needed.

Instrumental or intrinsic? Cultural policy in Scotland since devolution

An opinion piece on cultural policy changes in Scotland since devolution, presenting a view of the development of cultural policy in Scotland over the last 10 years. The changes in cultural policy are analysed using the definitions of intrinsic and instrumental policy. Analysis is presented from the perspective of a cultural agency working with both central government in Scotland and cultural service providers. Over the period of devolution there has been some policy shifts most notably the recent change from the Labour administration's approach of developing cultural entitlements, to the new administration's development of a National Performance Framework for all parts of government and all public bodies. This new “Framework” has a focus on outcomes and targets and the new government is seeking alignment from all to progress its core purpose of achieving “sustainable economic growth”. This policy change appears to denote a shift from attempting to take account of the intrinsic value of culture in cultural policy to an instrumental approach. What is not clear is if the outcome based approach of the National Performance Framework which appears instrumental in its design will in its implementation allow for the intrinsic value of culture to be implicit.

What do we mean by sustainable rural health services? Implications for rural health research

The concept of health service sustainability, endorsed by the Australian Health Ministers as a key dimension of the National Performance Framework, is particularly important in rural and remote communities. To date, however, few Australian studies have demonstrated how the real drivers of sustainability inter-relate or are translated into sustainable rural and remote health services. This article highlights the need for a systemic approach in which the integrated nature of sustainability components are recognised and evaluated in terms of access to rural and remote health services, quality of care and cost of provision.

The legal and ethical implication of evidence-based clinical guidelines for clinicians

The question that dental practitioners should be asking is whether theirpractice differs from published guidelines and, if so, is the deviation from theguideline justifiable.IntroductionThe quality agenda for health caredelivery can be divided into three mainoperational sections. First, the develop-ment of standards. This will be the roleof the National Institute for ClinicalExcellence (NICE) and identifiedthrough the National Service Frame-works. Secondly, the delivery of thestandards through clinical governance,which will involve continuing profes-sional development and, thirdly, themonitoring of the system through threearrangements; the Commission forHealth Improvement (CHI), the Na-tional Performance Framework and theNational Survey of Patient and UserExperience.Ashealthcareproviders,dentalpracti-tioners will need to demonstrate thatthey are adopting quality assurancemechanisms. A key feature of thesemechanisms will be to ensure that theyare meeting defined standards andtaking note of the appropriate clinicalguidelines.Theproliferationoftheterm‘guideline’, along with others such as‘protocol’or‘directive’,coincidingwithwell-publicised legal cases, may haveraised uncertainty and trepidation inthe mind of practitioners. In particular,the impact of such guidelines onindependent clinical judgement and itsrelationtonegligenceraiseunjustifiabledoubts. Indeed, one of the problemsfacing practitioners can be guidelinesthatmayappeartoconflict.Thosebasedon current policy at the time may notmatch those based solely on evidence.One example from the medical fieldwere the guidelines issued to HealthAuthorities on prescribing Viagra.This article highlights legal and ethicalissues surrounding guidelines to helpinform and hopefully reassure practi-tioners in their provision of care and, inparticular, to provide a framework toreduce the possibility of litigation.Legal issues associated with the use ofguidelinesThe legal basis for clinical guidelinescentres on whether they are profession-ally accepted and well-established prac-tice or statutory laws. The majority ofcurrent guidelines are the former andhave no force of statute. One majorexception concerns the provision of in-vitro fertilisation treatment. Under theHuman Fertilisation and EmbryologyAct 1990, the Code of Practice restrictsthe number of fertilised eggs to beplaced in a woman’s uterus to three.Failure to comply with the Code ofPractice may lead to a penalty beingimposed. However, most guidelinesrepresent professionally accepted prac-tice. How then do the courts assesswhether the standard of practice in anygiven individual case was appropriate?In UK law the ‘test’ applied centres onthecaseofBolamversusFriernHospitalManagement Committee (1957; theBolam test). In essence, it is a peer-group test by which a practitioner isjudged according to what a responsiblebody of medical opinion skilled in thatparticular field of health care wouldhave considered reasonable practice:‘‘a doctor is not guilty of negligence ifhe has acted in accordance with apractice accepted as proper by aresponsible body of men skilled inthat particular art’’.Variationinstandardscanexist.Thoseappliedtospecialistsmaybedifferenttothose applied to generalists

Assessing the performance of NHS Hospital Trusts: the role of ‘hard’ and ‘soft’ information

Formal performance measurement systems have become a prominent feature throughout most of the public sector. The NHS is no exception and the government is developing and expanding on existing performance data to produce a new national framework which is to be at the heart of the ‘performance-led’ NHS. The success of formal performance measurement systems depends in part on the degree to which they can capture adequately relevant information within a quantitative framework. In this paper, we explore the use of formal, quantitative ‘hard’ information and informal, subjective ‘soft’ information in the assessment of the performance of NHS hospital Trusts by external organisations. Our empirical work is summarised into 3 main themes: (i) the use of ‘soft’ information as a complement to ‘hard’ information; (ii) the use of ‘soft’ information as a substitute for ‘hard’ information; and (iii) the use of ‘hard’ information as a safety net in the assessment of performance. We argue that ‘soft’ information plays a valuable role in the assessment of performance of NHS Trusts and note that this is also reflected in current practice in the private sector. We argue that one of the main functions of ‘hard’ information in performance assessment is to act as a safety net in order to identify laggards by highlighting poor performance. Rarely is it used as a means to encourage good performance or to identify best practice. Whilst the safety net function may indeed be useful, if the new national performance framework is to achieve its aim of promoting good performance, the limitations of formal systems will have to be taken into account. We argue that the advantages of ‘soft’ information in the NHS should be acknowledged, rather than trying to force it into a formal framework where the benefits may be nullified. However, we also warn against excessive reliance on ‘soft’ information and suggest that a balanced system which allows both ‘hard’ and ‘soft’ information to flourish is the optimal solution to performance assessment in the NHS.