title: Toward a Culture of Consequences: Performance-Based Accountability Systems for Public Services.
abstract: Performance-based accountability systems (PBASs), which link incentives to measured performance as a means of improving services to the public, have gained popularity. While PBASs can vary widely across sectors, they share three main components: goals, incentives, and measures. Research suggests that PBASs influence provider behaviors, but little is known about PBAS effectiveness at achieving performance goals or about government and agency experiences. This study examines nine PBASs that are drawn from five sectors: child care, education, health care, public health emergency preparedness, and transportation. In the right circumstances, a PBAS can be an effective strategy for improving service delivery. Optimum circumstances include having a widely shared goal, unambiguous observable measures, meaningful incentives for those with control over the relevant inputs and processes, few competing interests, and adequate resources to design, implement, and operate the PBAS. However, these conditions are rarely fully realized, so it is difficult to design and implement PBASs that are uniformly effective. PBASs represent a promising policy option for improving the quality of service-delivery activities in many contexts. The evidence supports continued experimentation with and adoption of this approach in appropriate circumstances. Even so, PBAS design and its prospects for success depend on the context in which it will operate. Also, ongoing system evaluation and monitoring are integral components of a PBAS; they inform refinements that improve system functioning over time. Empirical evidence of the effects of performance-based public management is scarce. This article also describes a framework used to evaluate a PBAS. Such a system identifies individuals or organizations that must change their behavior for the performance of an activity to improve, chooses an implicit or explicit incentive structure to motivate these organizations or individuals to change, and then chooses performance measures tailored to inform the incentive structure appropriately. The study focused on systems in the child care, education, health care, public health emergency preparedness, and transportation sectors, mainly in the United States. Analysts could use this framework to seek empirical information in other sectors and other parts of the world. Additional empirical information could help refine existing PBASs and, more broadly, improve decisions on where to initiate new PBASs, how to implement them, and then how to design, manage, and refine them over time.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Stecher
authors.forename: Frank
authors.initials: F
authors.lastname: Camm
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Damberg
authors.forename: Laura S
authors.initials: LS
authors.lastname: Hamilton
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Mullen
authors.forename: Christopher
authors.initials: C
authors.lastname: Nelson
authors.forename: Paul
authors.initials: P
authors.lastname: Sorensen
authors.forename: Martin
authors.initials: M
authors.lastname: Wachs
authors.forename: Allison
authors.initials: A
authors.lastname: Yoh
authors.forename: Gail L
authors.initials: GL
authors.lastname: Zellman
authors.forename: Kristin J
authors.initials: KJ
authors.lastname: Leuschner
authors.forename: Frank
authors.initials: F
authors.lastname: Camm
authors.forename: Brian M
authors.initials: BM
authors.lastname: Stecher