The success of performance management in health care depends crucially on the response of health care professionals to the various instruments of performance management (PM). Yet we know little about how those professionals think and work. They may ignore PM for three reasons: ignorance of the relevant performance information; lack of faith in the credibility of the information; or inability to take relevant action. Furthermore, there is a risk that PM comes into fundamental conflict with the idea of professional autonomy and personalization of care. In order to create more effective PM policies, we need to know much more about professional motivations and constraints.

In his paper, ‘Incentivizing improvements in health care delivery’, Adam Oliver discusses recent efforts to manage the performance of health care workers in the United States and United Kingdom. Overall, the results of performance management seem to be mixed, but Oliver’s discussion hints at a more fundamental question about this approach, specifically: what are the limits of a focused instrumentality in a context as rich, fluid and collaborative as the delivery of health care? Might performance management schemes actually frustrate the efforts of conscientious health care workers? Indicators make few allowances for the heterogeneity of treatment effects or patient values or preferences. Health care workers may also face pressure to appear to satisfy indicators that are actually impossible to satisfy.

The commentary discusses key issues for assessment of performance management within health care. It supports the ambition to develop more realistic understandings of performance management based on insights from behavioral economics as suggested by Adam Oliver. However, it also points to several pitfalls and potential risks to consider when doing so. The commentary concludes that this is a promising field, but further research is needed to support the development of policy instruments.