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Health Policy. 2012 Nov;108(1):49-59. doi: 10.1016/j.healthpol.2012.07.008. Epub 2012 Aug 9.

Painting by numbers: a guide for systematically developing indicators of performance at any level of health care.

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Department of the Dean, School of Medicine and Health Sciences, University of Otago Wellington, PO Box 7343, Wellington South 6242, New Zealand.



There is a need for methods to facilitate selection of robust indicators in health care settings. This research aims to determine the key steps in, and delineate a systematic process for, construction of health care performance indicators.


Information derived from a review of the published literature and analysis of key informant interviews was synthesised to derive key activities and concepts fundamental to, and essential for, the development of robust and meaningful indicators. These activities and concepts were ordered into a logical sequence.


A sequence of six stages (prioritisation; intent; implementation requirements; measure specifications; indicator assessment; target development), with a series of steps within each stage, was delineated. This sequence comprises the Systematic Indicator Development (SID) Method, which may be utilised by health care policy decision makers, providers, or clinicians in a 'paint by numbers' manner to create robust and meaningful indicators, or to refine or amend existing indicators.


The SID Method blends different aspects of indicator art and science and structures it in a logical way to provide transparency, consistency and rigour to indicator construction. The approach ensures that all health care sector stakeholders can make informed decisions when selecting indictors or interpreting obtained results.

[Indexed for MEDLINE]

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