Part 1 of this series, explained the three dimensions of hospital performance: quality, access and price. This post covers the relationships between them.

It is tempting to try and maximise performance along all three dimensions simultaneously: improve quality, improve access and reduce prices (or costs). However, a hospital is a “system” and maximising performance of one part of the system does not necessarily result in maximum performance overall. The following diagram shows that a change to one dimension has consequences for the other dimensions.

It is management’s job to agree on what “high performance” looks like for their hospital. Different hospitals will have different priorities. In making these trade-offs, management will implicitly be acknowledging that performance metrics for some parts of the hospital are allowed to be sub-optimal, in order to maximise performance of the hospital overall.