Title: Performance and the National Health Service: Modelling for Formative Policy Evaluation and Strategic Planning

Author: Brijesh Patel

Year: 2006

Abstract: With the new public administrative practices, common understanding of the national policy instruments, such as the performance ratings, and consensus about their effects are important issues. This thesis addresses concerns of policy makers and participants by developing a quantitative method for formative evaluation of the policy instrument at a national level and analysis for related strategic planning at a local level.

      The structural analysis, which broadly consists of establishing inter-relationship between a set of issues for an organisation, is the core on which scenario analysis is built. The scenario analysis is developed in qualitative and quantitative phases. Qualitative scenario analysis looks into a specific intervention for the model system and synthesises the outcome behaviour. Quantitative scenario analysis, on the other hand, involves exhaustive possible interventions and their outcomes. By comparing prospective model-based system behaviour with the policy expectations, the results form the basis for the formative evaluation of performance ratings and for strategic planning for local units.

      Using Structural Equation Modelling the research develops a heuristic procedure for finding statistically significant relationships between empirical observations in the performance indicators published by the Department of Health (UK). Using causalloop diagrams a map of inter-relationships between various aspects of  measured performance is constructed. This defines the dynamical system for the research. Qualitative scenario analysis, a storytelling technique, formed a preliminary evaluation of the relationships between the performance indicators. Quantitative scenario analysis, using cellular automata based simulations of the dynamical system, provided comprehensive results for the formative evaluation of the sixteen performance indicators. It also provided a useful method for contextual performance positioning for the average local units, and a basis for strategic planning for mid-toii long term performance management. The further works aim to contribute by developing statistical constructs of the aspects of health care, and by establishing inter-relationships between them with the methodology introduced by the research.

      Given the important role that performance ratings play in the performance management of health care, the methodology for formative evaluation of the national policy instrument and the findings for strategic planning of the local units in this thesis should be of great interest to the department, health care policy-makers and advisors, and the providers and purchasers of health care.