Integration is not achieved through structure alone. It happens when providers work towards the same outcomes, using the same measures, and acting on the same information.
Most health systems are not short of data. The problem is that data sits fragmented across providers, platforms and sectors, so reporting increases while insight does not.
A coherent performance architecture operates at three levels: system-wide outcomes that define success, pathway measures that manage delivery across boundaries, and near real-time indicators that support day-to-day decisions.
Two enablers make this work: integrated data that creates a single source of truth, and governance that ensures stakeholders trust how metrics are defined and used.
The previous part of this series explored how shifting from funding activity to purchasing outcomes helps anchor pathways in reality. Defining outcomes in contracts is a critical step, but it does not in itself create integration. Once funding is linked to performance, the system needs a consistent way of understanding whether those outcomes are being delivered, where variation persists, and what action is required.
Why do health systems need a shared view of performance?
This is where the next layer of the Model of Care becomes critical. Integration is realised when providers work towards the same outcomes, use the same measures and act on the same information. That takes aligned data, reporting and accountability, as well as aligned intent.
True integration shows up in three places: shared outcomes, shared responsibility and shared visibility. In many health systems, these elements are not aligned. Strategic priorities are defined centrally, but operational teams are measured on different metrics. Data exists across organisations, but is not integrated in a way that supports decision-making. Reporting requirements increase, but insight does not. The result is a system that is busy, but not necessarily coordinated.
For the Saudi Model of Care, this creates a clear risk, and one the sector already recognises: in Philips’ 2024 Future Health Index, every Saudi healthcare leader surveyed said data integration challenges affect care delivery [1]. As pathways span primary, community, hospital and specialist services, no single organisation owns the outcome end-to-end. Without a shared view of performance, providers optimise locally, variation persists and accountability becomes diffuse. Standardised pathways and value-based purchasing can only go so far without a consistent way of measuring and managing delivery.
Who needs a shared view of performance in KSA?
Under Vision 2030 and the Health Sector Transformation Program, Saudi Arabia is separating the roles of regulating, purchasing and delivering healthcare. The Ministry of Health is moving away from care delivery to enact policy and regulation. Public hospitals and primary care centres are being transferred to the Health Holding Company, and the Center for National Health Insurance (CNHI) is becoming the single national purchaser. Each institution needs a different view of the same information.
CNHI needs to know whether the outcomes it is purchasing are being delivered, at pathway and population level, so it can link payment to results and move funding where value is not being achieved. The clusters need timely pathway measures that show where patients wait in the pathway, where they are lost between settings and which sites are outliers. Those pathways span their own hospitals and primary care centres and, increasingly, private partners. The Ministry, as regulator, needs assurance that quality and safety standards are met consistently across all clusters and across public, private and military providers, without running a parallel reporting system of its own. If each institution builds its own dataset and definitions, the Kingdom will end up with multiple versions of performance.
The three layers of a coherent performance architecture
Addressing this requires a shift from fragmented reporting to a coherent performance architecture. At the strategic level, a focused set of system-wide outcomes must reflect national priorities and purchasing objectives. These define what success looks like. At the tactical level, pathway-specific measures must enable clusters and providers to manage delivery across organisational boundaries. At the operational level, near real-time indicators must support day-to-day decision-making, including flow, access and escalation.
When these layers are aligned, the system moves from reporting activity to managing performance.
Two enablers: integrated data and strong governance
This alignment depends on two critical enablers: integrated data and strong governance.
Data integration is foundational. In practice, most systems are not short of data, but the data is fragmented across providers, platforms and sectors. For Saudi Arabia, this challenge is amplified by the scale of transformation and the diversity of the provider landscape, including integrating care across public, private and military health sectors. Creating a single source of truth requires integration across care settings, standardisation of definitions and interoperability between systems. It also requires clarity on ownership, so that data quality, completeness and timeliness are actively managed.
However, integration alone is not sufficient. Without governance, data becomes a source of debate rather than a basis for action. Shared dashboards only work when stakeholders trust the data, understand how it is defined, and accept how it will be used. This requires clear metric definitions, transparent methodologies, defined ownership and structured forums for reviewing performance and agreeing action. Governance is what turns data into accountability.
From dashboards to decisions
Dashboards then become the mechanism through which this information is made actionable. A good dashboard connects outcomes to their underlying drivers and prompts timely intervention; the volume of data it presents matters far less. Well-designed dashboards replace multiple disconnected reports with a single, coherent view of performance, tailored to different users and aligned across strategic, tactical and operational levels.
The importance of this approach can be seen in practice.
Case study: a command-and-control model with NHS England
In work delivered with NHS England, CF developed a command-and-control model to provide system leaders with a single operational view across Integrated Care Systems. Data from across acute, community, mental health and primary care services was integrated into a unified platform, with role-based dashboards aligned to decision-making needs. Governance frameworks ensured consistency and trust in the data.
What it delivered:
Case study: Improving value for money and care pathways for a large GCC health provider
CF built a bespoke framework, combining the National Health Strategy with the WHO Health System Strengthening framework, to benchmark the system against advanced health system peers. To do this, CF joined data from two providers into a single integrated dataset for the first time. Bringing together 12 million rows of data made it possible to calculate the burden of disease and compare performance with international practice. Stakeholder interviews then tested the findings and drew out the system’s strengths and gaps.
What it delivered:
- A first integrated view of performance across two providers, benchmarked against international peers
- Evidence that bed and workforce capacity would be sufficient once current buildings open and committed plans are delivered
- Clear opportunities for private sector involvement, including accountable care for specific population groups and outsourcing or expanding non-core services
As with the NHS England work, the value came from seeing the whole system in one place for the first time.
Implications for the Saudi Model of Care
Delivering integration at scale requires more than defining pathways and aligning incentives. It requires a shared performance architecture, underpinned by integrated data and strong governance, and designed to support decision-making at every level of the system.
This includes defining a core set of system-wide outcomes linked to priority pathways, integrating data across providers to create a single source of truth, and aligning reporting across strategic, tactical and operational levels. It also requires designing dashboards that reduce reporting burden rather than add to it, and governance mechanisms that ensure data is used to drive action.
Part 1 of this series argued that standardised pathways should protect both quality and equity, through transparent measurement of outcomes across demographics and geographies. A shared performance architecture is what makes that possible in practice.
For a cluster, this would mean each core outcome measure is broken down by area, by age and sex, and for the patients who find the system hardest to navigate, such as those with complex needs or those living furthest from services. Variation that disappears in a cluster-wide average becomes visible. A cluster serving both an urban centre and more dispersed communities might meet its overall target for diabetes control, while patients in outlying areas are reviewed far less often. Seen at that level, the response can be specific: extended primary care outreach, virtual follow-up, or a change in where specialist clinics are held.
The shift is from fragmented information to shared insight, and from isolated accountability to collective.
Looking ahead
Better data brings its own risk: too many metrics and too much reporting. In Part 4 of this series, we look at how to define the few measures that matter and reduce the reporting burden.
FAQ’s
About CF
CF is a leading consultancy dedicated to making an enduring impact on health and healthcare. We work with leaders and frontline teams to improve health, transform healthcare, embed life science innovation and boost growth through investment. With unmatched access to UK healthcare data and award-winning data science expertise, our team are a driving force for delivering positive and meaningful change.
About the authors
Nour Mohanna
Nour Mohanna leads business development for CF’s Middle East practice. Over the past decade, she has worked with ministries, health systems and life sciences organisations across the Gulf and the UK, partnering closely with their senior leaders. Her expertise spans health system strategy, performance and value for money, helping clients understand where their system stands and where to act. With a background in behavioural science and public policy, Nour brings a distinctive blend of analytical rigour and cultural fluency.
Elise Kearsey
Elise is a Senior Consultant at CF with a track record of supporting the design, adoption and operationalisation of national digital products in the NHS. She has worked extensively on the Federated Data Platform since its inception – including the redesign of the FDP Centre of Excellence, and deployment of the PHM Strategic Commissioning Tool across multiple ICBs – and has also provided strategic input into the digital aspects of the NHS 10-Year Health Plan. Elise brings particular strength in articulating the strategic value of central digital capabilities to senior NHS audiences and in driving sustainable adoption across federated organisations.
