Balancing the NHS balanced scorecard!

In the UK, the split between opposition and supporters views of the National Health Service (NHS) performance ratings system is growing. Objective argument and consensus would be facilitated if a methodology was developed which showed the cause and effect relationships between the components of the performance rating system. The NHS hospital trust performance ratings data used in 2002 and 2003 were downloaded from the Department of Health performance rating website. Structural equation modelling was used to construct a causal-loop diagram showing the cause and effect relationships between the 16 common performance indicators in the two years. Scenario testing suggests that indicators of delayed transfer of care and of data quality are compromised if emergency readmissions performance is improved.