Caroline Clarke: NHS must get better at measuring quality

Over the past decade or so, we’ve become used to the language of industry: turnaround, competition, marketisation, regulation and choice.

There’s nothing necessarily wrong with that, except that we seem to have lost a common language of caregiving − something that allows me as a finance director to quickly connect with a clinician or patient, and to authentically communicate with the groups of people who are going to have to transform our services to make them fit into the austerity backed NHS of the future.

‘You may be familiar with the glassy stare, awkward shuffle of papers and embarrassed silence when raising the cost issue’

Against this backdrop, we are now facing a distinct and sharp drop in public and political confidence, combined with a general malaise around investment in public services. Now more than ever, I need a common language that will allow me to unite with clinicians and other colleagues involved in delivering care.

Enter US academic Michael Porter and his work on value. Porter uses the concept of value systems in a number of industries to define a shared goal or result. In health, value is defined as the relationship between quality and cost across the whole patient journey.  

Defining quality

In my experience, not many people want to talk about cost. You may be familiar with the glassy stare, awkward shuffle of papers and embarrassed silence when raising the cost issue. If we can refocus the conversation to one about adding value to a patient’s journey, then we may all have a better time.

That means we have to define quality. The NHS has struggled for years with the question of how to measure quality effectively.

‘The evidential relationship between cost and quality is a bit inconclusive, largely because we have been measuring different things badly

However, it seems to me that we are now closer to coming to an agreement on a common way of looking at quality, and that we should wholeheartedly embrace this.

Lord Darzi and others have defined the elements of safety, clinical effectiveness and some emerging ways of calibrating human experience (how did I feel about the care you just gave me?). We must now urgently build this common language. 

Why is an accountant writing about this? Well, although the evidential relationship between cost and quality is a bit inconclusive, that is largely because we have all been measuring different things badly (including cost). In some areas, such as infection control, the relationship is obvious − but unless we start defining and measuring in earnest we’ll never know if we’re any good, if we’ve improved or how we compare to others.  

So who is good at measuring? Turns out the accountants have hidden uses. 

Caroline Clarke is finance director and deputy chief executive of the Royal Free London Foundation Trust