Performance Monitoring for a Sustainable Health System : New Wine, New Bottles?

Growing global interest in mitigating the climate impact of healthcare has called attention to the role of performance monitoring in delivering a sustainable health system. The aim of this chapter is to ask whether and how performance monitoring can be made to support this ambition. Healthcare sustainability impacts and indicators are a ‘new wine,’ and it may be that the ‘old bottles’ of performance monitoring will contain it poorly. This depends, in part, on the nature of the novel demands for performance monitoring arising from the pursuit of health system sustainability, and on how the existing strengths and weaknesses of health system performance monitoring manifest in this new context. More substantively, it depends on the degree of change required. If what is anticipated is a ‘greener’ version of current health systems, existing performance measurement systems can be made fit for purpose. If, however, whole-system transformation rather than incremental improvement is required, involving deep uncertainty and complex and emergent change processes - then traditional control and management approaches may be out of place. New bottles will be needed