Education And Debate

Measuring “goodness” in individuals and healthcare systems

BMJ 2002; 325 doi: (Published 28 September 2002) Cite this as: BMJ 2002;325:704
  1. Mike Pringle (, professora,
  2. Tim Wilson, directorb,
  3. Richard Grol, professorc
  1. aDivision of General Practice, University of Nottingham, Nottingham NG7 2RD
  2. bQuality Unit, Royal College of General Practitioners, London SW7 1PU
  3. cDirector's Centre for Quality of Care Research (WOK), Nijmegen University, Netherlands PO Box 9101, 6500 HB Nijmegen, Netherlands
  1. Correspondence to: M Pringle

    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.

    Summary points

    • Individuals and organisations constantly strive to define and measure quality of health care

    • Good data on quality of care are needed to achieve understanding and effective change

    • Data are often used out of context and without taking account of natural variation

    • A good measure of quality of care is appropriate to that task and is used appropriately

    • Twelve attributes can be ascribed to quality …

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