Targets, inspections, and transparency

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7440.598 (Published 11 March 2004) Cite this as: BMJ 2004;328:598
  1. Gwyn Bevan, professor of management science (R.G.Bevan@lse.ac.uk),
  2. Christopher Hood, Gladstone professor of government
  1. Department of Operational Research, London School of Economic and Political Science, London WC2A 2AE
  2. All Souls College, University of Oxford, Oxford OX1 4AL

    Too much predictability in the name of transparency weakens control

    For the past three years, the performance of NHS organisations in England has been assessed by performance (star) ratings based on targets—“key targets” and indicators in a “balanced scorecard.”14 In the first two years, NHS managers knew only (until about a week before publication) that ratings would reflect stated government priorities. In response to demands for greater transparency the Commission for Health Improvement, when it took over responsibility for the third set of ratings from the Department of Health, published lists of the targets to be used in advance of publication of ratings but during the year to which the targets applied. Demands have been made for greater transparency in the NHS—for example, by publishing full specifications of targets and how ratings are to be calculated before the start of each financial year. Such …

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