This document outlines a performance management framework with both procedural and structural components. The procedural framework is an 8-step process that involves establishing performance measures, aggregating safety data, using the data for decision making, disaggregating data to trigger actions, developing enablers for change, applying enablers to processes, coordinating changes, and evaluating the performance management system. The structural framework includes enabling technologies, organizational structures, performance indicators, and data models. Safety and efficiency measures are also compared.