Toward a Culture of Consequences

Performance-based accountability systems (PBASs) link incentives to measured performance to improve services to the public. Research suggests that PBASs influence provider behaviors, but little is known about PBASs' effectiveness at achieving their performance goals. This document explores the design and effectiveness of nine PBASs in five sectors: child care, education, health care, public health emergency preparedness, and transportation.

Preface	p. iii
Table	p. vii
Acknowledgments	p. ix
Abbreviations	p. xi
Executive Summary	p. 1
Research Approach	p. 3
Findings	p. 4
Decision to Adopt a Performance-Based Accountability System Is Shaped by Political, Historical, and Cultural Contexts	p. 4
Selection of Incentive Structures Has Proven Challenging	p. 5
Design of Performance Measures Requires a Balance Among Competing Priorities	p. 6
Successful Implementation Must Overcome Many Potential Pitfalls	p. 7
Evidence of System Effectiveness Is Limited and Leads to Varying Conclusions by Sector	p. 7
Recommendations for System Developers	p. 9
Design of the Performance-Based Accountability System	p. 9
Incentives and Performance Measurement	p. 11
Implementation	p. 12
Evaluation	p. 13
Areas for Further Research	p. 15
Concluding Thoughts	p. 16
Appendix: The Five Sectors	p. 17
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Toward a Culture of Consequences Performance-Based Accountability Systems for Public Services--Executive Summary

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