Development of performance indicators for the bovine clinical salmonellosis surveillance network in France.

Performance indicators are variables used to calculate on a continuous basis the operational level of a surveillance network's priority activities. A 10-step process was developed to enable network coordinators to identify specific performance indicators to help them monitor their networks. The methodology was based on a listing of surveillance activities, the definition and choice of network's global priority objectives, the construction of performance indicators and monitoring tables and the implementation of the system within the network. This process was implemented for the bovine clinical digestive salmonellosis surveillance network in France (RESSAB). The process produced a list of 26 activities synthesized into 15 global objectives, from which 12 were retained as priority objectives. This made it possible to develop 12 performance indicators. Indicators retrospectively calculated for the year 2003 indicated that RESSAB was operating according to the objectives set by the network's stakeholders and its financial supporter. The methodology was implemented successfully and was not very time consuming (12 person-days) or expensive. The decision makers and actors in the network quickly appropriated the system. The methodology can thus be considered validated through this example. Nevertheless, the risks inherent in the use of performance indicators must be addressed by ensuring the relevance of the selected indicators through external assessment and by prioritizing an internal and participatory approach to avoid a misuse of the performance indicators. In addition, considering that performance indicators address only the operation of the network, relevance of surveillance procedure should be addressed by external evaluation.