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Brief analytical summaries or syntheses #5

Opportunities and challenges in measuring the quality of care in England


Greater use of quality measurement in the National Health Service (NHS) has real potential for improving quality of care, efficiency and productivity. Changes in the economic climate in England since the publication of the NHS Next Stage Review in 2008 are challenging healthcare authorities to achieve demonstrable improvements in outcomes for patients but also greater productivity and efficiency.

This paper sets out the issues that need to be considered in developing and using indicators to measure quality. It attempts to define what is meant by ‘quality’ in health care, examine initiatives likely to improve quality and identify not only the potential benefits of quality indicators, but also the complexities and challenges involved in their implementation.


The transition from an NHS focused on targets, activity volumes and waiting times to one focused on the patient experience and outcomes has been broadly welcomed. The Department of Health has undertaken a review of the NHS where quality indicators will be developed and used at all levels (Next Stage Review) despite budget constraints. The challenge is to improve patient outcomes while increasing efficiency and productivity.

The main challenges arising from this change are the complexity associated with implementing indicators and the need to monitor quality in the context of pressures to improve productivity and efficiency.

Analysis and results

A number of practical issues need to be considered when choosing and using quality indicators:

  • current or new data sources
  • data coverage and quality
  • evaluation of data quality
  • rigor and validity of the methodology
  • local and/or national indicators
  • evaluation and refinement of indicators

A first set of about 200 Indicators for Quality Improvement (IQIs) was implemented in July 2009. The indicators will be added to, refined or retired over time and in response to feedback.

Organizations need the skills, engagement and capacity to develop indicators, collect and analyze data, and draw appropriate conclusions. This requires time, commitment and financial investment. The NHS is facing a more restricted financial future, and the challenge now is not just to achieve demonstrable improvements in outcomes for patients but also greater productivity and efficiency. However, for this initiative to achieve its potential, all involved – from national policymakers to clinical staff – need to be aware of and able to respond to the opportunities and challenges it presents.

Producing indicators that are technically robust and interpretable is only the start of the journey; enabling systems to use this information to improve patient care is the critical goal.


Implications and recommendations

A number of issues need to be addressed if quality indicators are to have an impact on patient care:

  • Clarify the different aims and needs of different audiences for quality measures.
  • Select the right indicators for the right purpose.
  • Secure clinical engagement.
  • Widen the scope of indicators.
  • Provide guidance on the interpretation of indicators.
  • Encourage health professionals to improve data quality.
  • Continually monitor the relevance of indicators.
  • Develop necessary skills and capacity.
  • Make optimal use of existing data sources.


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