Performance: a multi-disciplinary and conceptual model.

We contend that the scientific study of performance requires a model or paradigm. We propose a performance model with an underlying mathematical basis that is well defined, has explicit assumptions and has the potential to be both heuristic and scientifically testable. The model is based on an integration of concepts from health sciences and psychology that have been adapted to performance measurement in health care. The proposed performance model consists of a combination of four primary elements: quality of care, cost of care, access to care and satisfaction. Satisfaction is defined as a function of perceived and expected outcomes of care and perceived and expected input. This performance model can serve as both a tool for understanding and as a vehicle for comparing performance within and between health care organizations. We believe that this model can be used to develop a performance profile report and the future report card.