Performance management introduced to the senior health executive levels in the New South Wales public health care system included the senior executive service in 1989 and, as a key element of that service, performance agreements in 1990. This is the first qualitative study examining senior health executives? personal experiences of these changes. In consideration of what has been learnt from the most relevant literature and this study, this paper concludes that the introduction and implementation performance management is a continuous process. This process includes the key steps of planning, measuring, monitoring and evaluating. It can be used as a means to achieve overall effective organisation performance by bringing in a two-way management process for the organisation and its senior health executives.