[Performance indicators unsuitable to monitor and improve complex health care]

Medically, socially and legally doctors are expected to deliver care of sufficient quality. Adequate quality is never self-evident. Patients and payers increasingly demand public disclosure of the condition ofhealthcare. Performance indicators have been created for this purpose, but how adequate are these measures? The problem is complex, making single performance indicators, such as the percentage of patients with traumatic hip fracture who undergo surgery within 24 hours after admission, inadequate. Improving quality requires not only proper measurement to disclose weaknesses and monitor the road to recovery but also better motivation of healthcare professionals. Pay-for-performance does not address the basic problems ofhow to measure and improve care. Doctors have to change the culture of medicine and find ways to deal with the increasing complexity of medical care.