An outcome-driven Performance Measurement (PM) framework is currently mandated by the Ministry of Health to monitor the performance of public hospitals. This measures DHB performance against national targets. Although such a framework is consistent and of value, it fails to address the systemic nature of operational performance. A balanced PM framework will consider: inputs (e.g. resource allocation, strategic planning); process efficiency and effectiveness; outputs (performance measures); and outcomes (consumer and public perceptions of the processes and outputs). The Balanced Scorecard (BSC), a PM framework originally developed for businesses, remains the most widely used model by health care organisations globally. This model has well-documented shortcomings. The proposed research will develop an innovative performance measurement framework that relates to NZ public hospitals and their full range of systems. This framework will be constructed using the developing methodology of Structural Equation Modelling, coupled with qualitative (rich) data collection and a model validation stage.