Performance, Evaluation and the Nhs: A Case Study in Conceptual Perplexity and Organizational Complexity

This paper adopts a comparative perspective towards the analysis of performance evaluation in the National Health Service. The NHS, it is argued, is best seen as an organization which is not unique but which ranks high on a number of dimensions: uncertainty about the relationship between inputs and outputs; heterogeneity of activities and aims; the ambiguity of the available information. These factors help to explain why performance evaluation in the NHS is both conceptually and organizationally problematic, and fragmented and professionalized in practice. By looking at the same factors in other organizations, it may be possible to start constructing a framework for examining the problems of performance evaluation in different settings.