RESUMO
Performance management is an important mechanism for ensuring accountability and improving the quality of health-care services. The last decade has witnessed a proliferation in the development of performance measurement systems for assessing health-care processes and outcomes at the program, hospital, district, system and national level. This has allowed for comparison and benchmarking between similar aspects of care at each of these levels. Unfortunately, most performance systems are devoid of clear mechanisms for translating feedback from measures into strategies for action, thus leaving largely unfulfilled the quality and management aspect necessary to improve health-care services. Therefore, the thinking that goes into designing these systems must change. This article outlines a management framework called systematic outcome mapping that provides for performance management rather than just performance measurement by allowing for quality improvement to be built into performance indicator development. It utilizes evidence-based medicine and expert consensus opinion to establish linkages between processes of care and their outcomes with the clear intent that feedback from information provided by performance indicators can be used to modify health-care activities so as to improve health outcomes. This fulfils the quality improvement aspect of performance measurement and makes it an integral part of a performance management framework that reinforces organizational learning through feedback from outcomes and the assessment of organizational routines.