System Performance Measurement: Implications for Service Planning

152 IMPROVING PERFORMANCE OF HEALTH and social services is imperative in the face of increasing population needs, complex and chronic patient profiles, and resource scarcity. These three related articles (Performance measurement in mental health and addictions systems: A scoping review; The experience of the treatment demand indicator in Europe: A common monitoring tool across 30 countries; A mixed-methods evaluation of the implementation of a performance measurement system for South Africa’s substance use treatment services) assess numerous system-level efforts undertaken in recent decades and aim at conceptualizing, implementing, and monitoring performance measurement, both in Canada and internationally. Urbanoski & Inglis (2019) report the results of a scoping review on performance measurement in mental health and addiction treatment systems, concluding that a wide variety of indicators is available to those designing a measurement system. Myers et al. (2019) extend this review to cover performance measurement systems for lowand middle-income countries (LMICs) such as South Africa, showing that it is feasible to implement performance measurement systems in LMICs if the system is acceptable, appropriate, and useful. Finally, Montanari et al. (2019) demonstrate the utility of implementing a common treatment demand indicator in Europe, across 30 countries. These articles suggest that performance indicators permit the follow-up and evaluation of system reforms focused on improving organizational efficiency and interdisciplinary teamwork, while implementing best practices geared toward better population health and patient recovery. Yet consensus is lacking around the meaning of performance: Conceptual frameworks vary according to the programs evaluated (e.g., substance use disorders [SUDs], mental disorders) and across countries. Donabedian’s Quality Framework, a simple and perhaps best-known model, integrates structure, process, and outcomes. Structure encompasses both organizational and provider characteristics and context, whereas process includes interactions between providers and patients regarding treatment. Outcomes relate to the effects of health care for both population and individual health status including patient satisfaction (Donabedian, 1972). COMMENTARY