How do you improve performance in public services?
England governed its public services through targets, star ratings and inspection; Wales and Scotland mostly did not. That left a natural experiment: two ways of running the same services. Gwyn and Christopher Hood found that the English regime taught staff to game the measures. Gwyn worked inside the English government’s drive to transform the performance of the NHS, and saw nothing of the kind happen in Wales. He has since put the same question to ambulance services, which each part of the UK measured in its own way.
Using targets with and without sanctions for failure
- Have targets done more harm than good in the English NHS? No
- Hitting and missing targets by ambulance services for emergency calls: effects of different systems of performance measurement within the UKWhat happened to ambulance response under different systems of measurement in the UK.
- Have targets improved performance in the English NHS?
- Setting targets for health care performance: lessons from a case study of the English NHS
- What’s Measured is What Matters: Targets and Gaming in the English Public Health Care SystemTargets in the English NHS, and how staff gamed them.
- Targets, inspections, and transparency
The power of incentives from publishing performance information: ‘naming and shaming’ and ‘naming and faming’
- Reputations Count: Why benchmarking performance is improving health care across the world
- Does ‘naming and shaming’ work for schools and hospitals? Lessons from natural experiments following devolution in England and Wales
- Models of governance of public services: empirical and behavioural analysis of ‘Econs’ and ‘Humans’
- Naming & Shaming: the impacts of different regimes on hospital waiting times in England and Wales
Problems in estimating needs of populations from unwarranted variations
- A population health approach to reducing observational intensity bias in health risk adjustment: cross sectional analysis of insurance claimsTests two measures of risk that do not rest on recorded diagnoses, and finds they explain actual mortality better than the index Medicare uses.
- Observational intensity bias associated with illness adjustment: cross sectional analysis of insurance claimsAdjusting for illness using recorded diagnoses makes the regions whose doctors see patients most often look as though they have lower mortality and lower costs.
Other papers
- Improving public services through ambitious targets and tough sanctions for failure
- Incentives and models of governance
- Evidence of the impacts of different models of governance and reporting systems on quality of health care
- A million years of waiting: competing accounts and comparative experiences of hospital waiting time policy
- Regulation and system management
- What's in a wait? Contrasting management science and economic perspectives on waiting for emergency care
- How might information improve quality of care in the English NHS?
- A third way