Measuring “goodness” in individuals and healthcare systems

All agree that we need to measure the quality of health care, including the care given by individual doctors. Measuring “goodness” requires accurate data used appropriately, and it must be done without demoralising and demotivating staff. Do current measures fulfil these requirements, and if not, what measures should be used?

In the recent Reith lectures (broadcast annually by BBC radio on issues of contemporary interest), Onora O'Neill explored the new age of accountability. She concluded that increasing reliance on measurement reduced trust in health (and other public) services and that professionals and public servants should be free to serve the public.'1 This will ring true with many.

However, patients, funders, commissioners, provider organisations, and health professionals legitimately want to know just how “good” are individual doctors, teams, and healthcare providing organisations. The traditionally qualitative, anecdotal approach, supplemented by trust, is being increasingly replaced by data on effectiveness, safety, acceptability, and efficiency.

Measurement is crucial for a range of purposes—learning, quality improvement, accountability, and regulation—but must be used appropriately. We contend that measurement can be used to reinforce the natural desire of healthcare staff to improve care at the same time as understanding the quality of the service delivered.

However, creating meaningful information from accurate data to facilitate rational choices is a real challenge. It must be done without distorting staff behaviour or demoralising and demotivating health professionals (including managers), and it must offer true comparisons.