England in 2001 introduced an annual ‘star rating’ system for the public health care institutions. As a result, managers in health care were prone to being fired if the results reflected poor performance when measured and were subjected to ‘naming and shaming’ for poor performance (Anonymous 2001). It was believed to bring a positive change, however, the central government intervened constantly to avoid destabilization of hospitals in the market (Tuohy 1999). Labour tried to introduce a new system that allowed for better functioning and fund management through a target and terror system in tandem with the annual ratings system for governance. This system was widely applied to organizations in England and formed a part of an extensive control system monitoring public service performance. Two agencies central to this were the Prime Minister’s Delivery Unit (focusing on key targets of public service) and the Treasury (connecting budgeting with performance targets). Another additional overseer was the Department of Health.

With multiple monitors, the system produced improvements (on the face of it) in English NHS reports. It showed reduced time spending by patients in the accidents and emergency rooms, increased satisfaction, waiting times were shortened dramatically after the introduction of star ratings between 2000-01. However, the NAO (2001) produced reports highlighting the adjustments made by 9 NHS trusts to their waiting lists, some due to pressure from outsiders. These adjustments could be attributed to the staff who manipulated the figures and following established procedures incorrectly. This study then gave way to another report conducted by the Audit Commision with similar deliberate manipulations and misreporting of the waiting list statistics. Few of the misreports were caused by cancellation and delaying of appointments which were recorded as an outlier of the target and terror system. Rowan et al. (2004) discovered no connection between the quality of critical care for adults and performance-based star rating systems.

Suggestions for Improved Measurement

Just like scientific representations, measures should hold objectivity, accuracy and non-reaction in its definition and adaptation. At the same time these standards should reflect worker’s performances and shape their goals. Reactivity should only follow careful consideration by an individual, offering a break between measurement and its reactivity. The blur between object and standards caused by reactivity threatens the efficiency and validity of said standards. When a standard becomes a target or goal, it ceases to be a good performance measure (Strathern 1996, p.4).

Auditing – There should be an alignment of expectations between the audit product and the opinions of the actor analyzing the reports such as the auditees. These expectations must also be realistic and more transparent in nature. Molding the preoccupation of individuals with their perception of performance and quality.

Re-incorporation of trust into institutional languages and rehabilitation of autonomy in some way to displace the distrust empowered by auditing institutions and bring back critical analysis of reports without turning a blind eye to it based on faith in autonomous auditing organizations. These standards can be supplemented by both qualitative and quantitative concepts. Reworking the auditing boundaries by segregati