Quality measures: bridging the cultural divide.

‘You can’t expect Joe Six-Pack to be Bob Brook.’ That was an off-the-cuff remark thrown into a heated debate about publicly reported high-quality data at one of the ‘Pennyhill Park’ health policy annual events hosted by the Commonwealth Fund and the Nuffield Trust. Robert H Brook, former director of RAND Health, has been a colossus in the field of healthcare quality measurement for over 30 years. The sentiment expressed in that remark captures the essence of the dilemma of establishing a policy on the collection and use of data to assess the quality of a healthcare system. We need enough of the right kind of data to draw reliable and valid conclusions about the performance of a hospital or health service, but the resulting analysis cannot be so technically challenging as to overwhelm its users, including the potential recipients of care and managers of the health system. Most chief executive officers in the English National Health Service (NHS) are not health professionals, and vanishingly few are sophisticated health services researchers. Attempts to overcome this problem with less complex data and messages may end up as simplistic and misleading. Meyer et al in this issue of the Journal, express concern at the ‘sky-rocketing’ number of quality measures that are now required for accountability purposes in the US healthcare system, and predict that they could easily move over the next few years from the current hundreds of metrics to thousands. We compare their critique of the place of quality measures in the US healthcare system to the context of the NHS as it undergoes fundamental redesign to its structures and accountability mechanisms. MONEY AND ACTIVITY VERSUS QUALITY: A FALSE DICHOTOMY