Measuring performance and missing the point?

doi:10.1136/bmj.39377.387373.AD

BMJ 2007;335:1075-1076 (24 November), doi:10.1136/bmj.39377.387373.AD

Analysis

Measuring quality through performance

Measuring performance and missing the point?

Iona Heath, general practitioner¹, Julia Hippisley-Cox, professor of clinical epidemiology and general practice², Liam Smeeth, professor of clinical epidemiology³

¹ Caversham Group Practice, London NW5 2UP, ² Nottingham University, Nottingham NG7 2RD, ³ London School of Hygiene and Tropical Medicine, London

Correspondence to: I Heath iona.heath@dsl.pipex.com

Targets do not necessarily translate into improvements for serviceusers. Iona Heath, Julia Hippisley-Cox, and Liam Smeeth arguethat performance measurement in the UK is shifting focus fromwhat each patient needs and those who need it most

The first 150 words of the full text of this article appear below.

Since April 2004, the performance of general practitioners hasbeen measured and remunerated against a limited, although increasing,number of easily measurable clinical activities. This initiativeis unique worldwide and is attracting considerable internationalinterest. It therefore behoves us to think critically aboutwhat we are doing.

General practitioners have responded by systematically recordingthe listed activities, apparently performing well above expectation,and the whole exercise has been hailed as a success for qualityof care. Despite evidence that these sorts of incentives improvethe quality of documentation while having a much more limitedeffect on underlying standards of care,¹ there have undoubtedlybeen useful achievements. Of these, probably the most substantialare improvements in diabetic control and innovations in computerprompting systems. However, the system is in danger of missingthe point of both quality and general practice.

The clinical activities that are measured and rewarded by thequality . . . [Full text of this article]

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