Performance measurement systems provide an opportunity not only to determine if organisations are effectively delivering their strategy and meeting their vision, but also to enable improvements. In 2009, the NHS implemented the NHS Performance Framework (Department of Health 2009), which has since been altered yearly in line with changing governments and policy alterations. Although originally designed to
be applied to Primary Care Trusts (PCTs) from April 2010, the NHS reform, which seeks the replacement of PCTs with GP Consortia, has rendered the framework
redundant in primary care (Department of Health 2010a). Since then, the NHS Outcomes Framework (Department of Health 2010b) has been published, and focuses on 5 outcome domains that are expected to show national level performance across the whole of the NHS. This high level system has failed to provide a performance picture of any individual service, of which there are many, in
addition to proving reliant on outcome (lagging) indicators which have long been recognised as a poor singular method for measuring performance (Eccles and
Pyburn 1992; Kaplan and Norton 1992). This study advocates service specific performance measurement and the engagement of stakeholders during the design
process to develop leading and lagging indicators of value to the stakeholders. This is in particular with efforts to shift the onus onto patients to maintain health; as is true
of the case management programme, which forms the case study for this research. The case management programme aims to reduce expensive hospital admissions for patients with complex long term conditions (LTCs) (Department of Health 2005). It expects to be able to achieve this by implementing a case management approach to oversee the most at risk patients, to develop an integrated care plan and to empower patients to become actively involved in their care at home. This paper will present the underlying literature that supports the development of a safety measurement model and describes the methodology used to gain validation by a key stakeholder group
