Health care has provided lessons for
court administration in the past (see Monitoring
“Never Events in Court Administration, Made2Measure, September 23, 2008; Pursuing
Perfection – A Lesson from Health Care, Made2Measure,
November 1, 2006. This time it provides a cautionary
tale, specifically for performance measurement and performance management.
The Story of PICS
reported in the Economist (“From petrol to prescriptions,” June 16, 2012. p.
65), the Queen Elizabeth hospital in Birmingham in the U.K. pioneered a new
approach to patient care learned from the carmaker BMW’s engine assembly
factory where over 99.9% of tasks were completed flawlessly. Big health systems
in the U.K. and the U.S., in contrast, tolerate many more errors.
BMW’s approach to manufacturing, the Birmingham hospital system installed a
quality-control regime called PICS, which stands for “Prescribing, Information and
Communication System.” PICS features a performance dashboard system on a
computer screen in every in-patient ward displaying such performance measures
as hospital-borne infection rates following surgery and the number of falls by
frail patients. Efficiencies that are benchmarked against comparable wards and
past performance are continually monitored by staff and management in real
time. No doubt, the Birmingham hospitals had the right measures and the right
delivery system in PICS to get the right measures to the right people in the
right way and at the right time.
Birmingham experiment was welcomed by Britain’s health-care establishment as
Queen Elizabeth’s mortality rates fell and errors that lead to poor patient
care decreased. Other hospitals with poor performance contracted out patient
care to Queen Elizabeth.
this is where the good story ends. The Birmingham experiment has stalled. It
seems that Britain’s National Health Service (NHS) is not into bold thinking as
it is preoccupied with austerity. It emphasizes the universality of care
provided rather than its outcomes. Hospitals do not compete with each other.
Successful innovations like PICS do not spread because NHS has no mechanism for
ensuring that they do.
lesson of this cautionary tale is that it’s not sufficient to identify the
right performance measures and even to build the right delivery mechanisms like
PICS, a modern performance dashboard system. A performance measurement and
management system is not self-executing. Users of performance data need to act
on the problems or opportunities that the data reveals on a regular and
continuous basis and have the incentive to do so.
courts, the right use of performance
measurement will not happen unless
courts implant performance measurement and performance management into the very
DNA of their governance, management practices, and daily operations. It will
not happen until the courts make innovations such as assigning new
responsibilities, instituting specific policies, creating governance
structures, and starting processes, procedures and practices to ensure
adoption, implementation and institutionalization of a performance measurement
and management system.
Right Measures, Right Delivery and
the right performance measures for an individual court or court system, and
making sure that they are used effectively, can be translated operationally
into three key requirements and corresponding phases of development: Right
Measures - identifying and developing the right performance measures; Right
Delivery and Distribution. ensuring that the right measures are
delivered to the right people, at the right time in an easy to understand way
(increasingly, this is done by computer-based performance scorecards or
“dashboards” that let users view critical performance information at a glance,
and move easily through successive layers of strategic, tactical and
operational information on a self-help, on-demand basis; and Right
Use. adopting, implementing, and integrating the measures performance,
as well as the delivery system and distribution system (e.g., performance
scorecard or dashboard), with key management processes and operations,
including budgeting and finance, resource and workload allocation, strategic
planning, organizational management, and staff development.
can’t just throw an innovative performance measurement and management system
“over the wall” to executives, managers and staff to adopt and to implement.
Even well-conceived, well-designed systems are unlikely to get implemented
unless they are woven into the very fabric of a court’s management practices
© Copyright CourtMetrics and the National Center for
State Courts 2012. All rights reserved.
Labels: Health Care, Right Use