Quality measures can improve quality of care but risk misinterpretation says The King's Fund

Greater use of quality measures in the NHS has real potential for improving the quality of care, but care must be taken to avoid misleading patients, distorting priorities and damaging staff morale, says The King's Fund today.

The quality and safety of health care is complex and challenging to measure, and the measures used are often difficult to interpret. In its discussion paper, Getting the measure of quality: Opportunities and challenges, the Fund sets out the issues that should be considered in developing and using indicators for measuring quality.

Among its key recommendations, the Fund stresses the need to avoid misinterpretation and confusion by being clear about the different audiences for quality measures and how they will use them.

It also suggests that the NHS should widen the scope of quality measurement to include measures of productivity, efficiency and inequality, as well as those that capture quality across patient pathways.

Veena Raleigh, lead author and senior fellow at The King's Fund, said:

'While openness and transparency are desirable, the increase in published information measuring the quality of care means it is imperative that adequate consideration is given to the selection, presentation and interpretation of complex data.

'Where such measures are used as performance indicators they must be interpreted with care in order to avoid unintended consequences, such as gaming, risk-aversion or distortion of clinical priorities.

'It is also important to remember that meeting performance indicators is not necessarily the same as good care for the individual patient.'

Other recommendations include:

  • Improve measures used for performance management and external assessment to reduce ‘gaming’ the system
  • Ensure clinicians are engaged in the development of performance measures and are empowered to use data to understand where and how to improve their own performance
  • Take steps to minimise the risk of misinterpretation and confusion among patients and NHS organisations when reporting data publicly.

Read the report: Getting the measure of quality: Opportunities and challenges

Notes to editors: 

  1. For further information or interviews, please contact The King’s Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2603. An ISDN line is available for interviews on 020 7637 0185.  
  2. The King’s Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, we help to shape policy, transform services and bring about behaviour change. Our work includes research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas.