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Fielden and Mountford (1) suggest that we should seize on a concept
of 'value' in our consideration of healthcare. They regard cost and
quality as too often two separate conversations, which rarely meet.
Since the Institute of Medicine's report Crossing the Quality Chasm
defined the domains of quality in 1990 (2) there have been many variations
of this categorization of the term. Most have included some consideration
of cost, often labelled as cost-effectiveness or efficiency, as one of
their constituent parts(3).
In promoting the worth of 'value' as a concept, they have rearranged
the terms in the quality equation, but not the meaning of the equation
We have learned from the myriad reorganisations and renamings of NHS
structures that changes in terminology lead to loss of understanding and
We were just starting to get used to the concept of 'quality', and
the depth of its meaning. Now is not the time to change the language.
1. Fielden J, Mountford J. A chance to optimise "value" in the NHS.
2. Institute of Medicine. Crossing the Quality Chasm: A New Health
System for the 21st Century. Washington, D.C: National Academy Press;
3. Kelley E, Hurst J. Health Care Quality Indicators Project
Conceptual Framework Paper. Organisation for Economic Co-operation and
Development: Paris; 2006.