OnlineOpen: This article is available free online at www.blackwell-synergy.com Summary. Following devolution, differences developed between UK countries in systems of measuring performance against a common target that ambulance services ought to respond to 75% of calls for what may be immediately life threatening emergencies (category A calls) within 8 minutes. Only in England was this target integral to a ranking system of 'star rating', which inflicted reputational damage on services that failed to hit targets, and only in England has this target been met. In other countries, the target has been missed by such large margins that services would have been publicly reported as failing, if they had been covered by the English system of star ratings. The paper argues that this case-study adds to evidence from comparisons of different systems of hospital performance measurement that, to have an effect, these systems need to be designed to inflict reputational damage on those that have performed poorly; and it explores implications of this hypothesis. The paper also asks questions about the adequacy of systems of performance measurement of ambulance services in UK countries.

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The EPSO has been a powerful driver for undertaking cross-European research, and this project is the first of many to take advantage of the access to international expertize. It has shown that through development of a framework that deconstructs national indicators, commonalities can be identified. Future work will attempt to incorporate other nations' indicators, and attempt cross-national comparison.

Since the 1990s the US and UK healthcare systems have increasingly sought to measure the quality of services in order to stimulate improvement and publish the results. Despite the very different healthcare systems, there are some striking similarities in the results of these schemes. In both countries information that creates the threat of reputational damage and the possibility of gaining kudos is particularly effective in stimulating a response. However, these responses may be perverse: gaming, falsifying of data and measurement fixation have all been uncovered. In the UK context, information is closely aligned to the regulatory and performance management framework, and there should be a role for the new Care Quality Commission in the emerging 'information landscape' of the NHS in England.