Dark Side - The Essential Handbook for GP Training & Education

The ‘Dark Side’ of Quality Measurement
 Marshall M, Campbell S, Hacker J, Roland M (2002). Quality Indicators for General
Practice. A practical guide for health professionals and managers. London: Royal
Society of Medicine Press Ltd.
 The Kings Fund (2011): ‘Improving the Quality of Care in General Practice’ available
online at: www.kingsfund.org.uk/publications/gp_inquiry_report.html
The Dark Side
Are you interested in assessing quality for regulation and performance management? Are you
more interested in getting some numbers and figuring out what they say and then grilling the
relevant people to find out why they’re underachieving? Do you believe that it really doesn’t
matter what people say but you can’t argue with the figures – that the figures don’t lie? If
your answer to most of these is yes, then you probably don’t understand the true ethos behind
quality measurement. You need to go back to the drawing board and learn a bit more about
quality from others around you before putting anything into action. Otherwise, you’ll be like
a bull in a china shop and you will wreck everything in sight.
You will end up:
Encouraging a fragmented, rather than holistic and integrated, approach in general
Failing to encompass important yet subjective aspects of general practice
Using data and information that is of poor quality, is difficult to access
Having difficulties in interpretation, for example, whether differences in care
standards represent real differences in quality of care or the presence of confounding
factors such as case-mix and case severity
Making the quality indicators expensive and time-consuming to produce. The cost–
benefit ratio of measuring quality is largely unknown
Encouraging a culture of blame rather than internal professional motivation
Encouraging a short-term rather than long-term response to quality improvement
Eroding public trust and professional morale as deficiencies are highlighted
Encouraging manipulation of data if you start publishing the results
Encouraging clinicians to focus on the counted rather than the patient, while areas of
care not covered by indicators risk being ignored
Implementing indicators even where the evidence of their benefit is not strong
Implementing indicators that cover only a minority of clinical activity
Dr. Ramesh Mehay, Programme Director (Bradford VTS), April 2011
The Angelic Side
Are you interested in quality because you want to see how you are doing and because you
have a genuine interest in wanting to improve things? If your answer is yes and you’ve got a
good understanding of the true meaning and ethos behind quality measurement you are more
likely to achieve the following things when you come to putting things into practice.
Hopefully, your approach will:
Allow comparisons to be made between practices against set standards over time to
stimulate and motivate change
Facilitate an objective evaluation of a quality improvement initiative
Help identify unacceptable performance and improve accountability
Stimulate an informed debate about the quality of care
Focus attention on improving the quality of information in general practice
Be a quicker and cheaper tool than other quality improvement methods, such as peer
Help target resources to areas where quality needs improving to meet needs
Improve public engagement and professional pride when quality targets are met and
Dr. Ramesh Mehay, Programme Director (Bradford VTS), April 2011