Performance measurement and the UK emergency ambulance service: Unintended Consequences of the ambulance response time targets

Purpose – The purpose of this paper is to assess the performance measurement in the UK NHS ambulance service documenting various unintended consequences of the current performance framework and to suggest a future research agenda. Design/methodology/approach – The paper reviews the literature on ambulance performance targets and documents several unintended consequences of the current performance system through an in-depth case study analysis based on interviews with Trust staff and policy experts along with observation of performance review meetings in the chosen Trust. Ethical approval for the study was obtained from a local NHS research ethics committee. Findings – Significant unintended consequences of the ambulance performance targets based on response times have been systematically documented, which are likely to put the target under spotlight, especially that of the eight-minute response. The current policy focus to reform the eight-minute target by making it more stringent has the potential of jeopardising the reform agenda based on developing clinical skills of the paramedics and introducing clinical management in the service. Practical implications – The paper makes an objective assessment of the sustainability of the current policy framework and identifies future lines of enquiry for further research. Originality/value – This paper makes an original contribution in identifying and documenting the disjuncture between stated and unintended consequences of ambulance performance measurement, which will be of value to academics, practitioners and policy makers

A Balanced Judgement?: Performance Indicators, Quality and the English Ambulance Service; some issues, developments and a research agenda.

A significant feature of the 'New Public Management' has been the particular emphasis it placed on public sector organisations measuring their performance. However, in practice, this has often been carried out in ways which proved dysfunctional: for example, by concentrating on a single dimension of performance, perverse incentives and unintended consequences arise. The previous performance measurement regime for the English ambulance service was regarded as a classic example of this since it concentrated on response times at the expense of other aspects of performance, such as the outcomes of treatment at the scene. However, that regime has been replaced by a 'dashboard', containing a wider range of performance indicators. At the same time, NHS organisations (including ambulance services) have to produce annual Quality Accounts. Thus English ambulance services are now faced with two new performance measurement regimes. Both of these seem, in principle, an improvement on the old regime; but also seem somewhat contradictory in their 'philosophies'. These developments are worthy of further exploration and, in this paper, we set out a research agenda, whilst placing the issues in the context of debates concerning multi-dimensional approaches to performance evaluation, such as the Balanced scorecard and Tableau de Bord, and, more generally, the 'paradox of performance' in public services