School of Management

The Centre for Public Services Organisations

Managing medical performance: the impact on clinicians and organisations

Dr Mark Exworthy (RHUL), Prof. Jonathan Gabe (RHUL), Prof. Ian Rees Jones (Bangor)

Interest in measuring and managing performance is widespread across the UK public sector. Performance indicators are used to improve quality, to stimulate comparisons and to identify areas in `need of remedial action.’ In the UK health-care context, performance indicators have traditionally measured organisational dimensions (such as activity or staffing). Assessment of clinical performance (of doctors) has been limited to (medical/clinical) audit; it has usually been the domain of doctors themselves. The definition of standards, measurement of practice and management of poor performance have remained within professional discretion.

In an era of greater patient choice and competition between health-care providers, clinical indicators have the potential to challenge medical autonomy and power, especially as they are likely to be coupled with greater public openness and transparency. Research on the likely impact of greater use of and public availability of these indicators is limited. However, consequences are likely to be felt in three main areas:

  1. Clinical/professional autonomy: Clinical indicators of performance might pose a threat to professional autonomy and change the role of managers and external stakeholders (such as GPs or regulators) vis-à-vis hospital doctors. As a result, new modes of control of clinical performance are likely to emerge.
  2. Inter-professional and user/professional relationships: Any performance `regime’ will be unable to cover performance dimension and convey them appropriately. Performance is difficult to measure where practitioners have discretion. Clinical indicators may erode trust amongst clinicians and between them and their patients. They may be resisted by clinicians if tied explicitly to payment and competition policies.
  3. Patient/Consumer behaviour: Published performance data are hardly used by the public but might begin to shape patient/consumer behaviour as they become more widely available.  They might also have a role in promoting accountability (within or beyond the hospital).

The project aims:

Project Team

Dr Mark Exworthy, School of Management, Royal Holloway, University of London.

Professor Jonathan Gabe, Department of Health and Social Care, Royal Holloway, University of London.

Professor Ian Rees Jones, Bangor University

Conference Presentations

* Copies available upon request

In collaboration with:

The Department of Health & Social Care at RHUL.

Project outputs

» Project findings (poster) PDF

Read more about this project at


» Featured as ESRC 'impact case study'