King’s Fund warns on quality measures

Greater use of quality indicators in the NHS could be a powerful tool to improve care, but could also lead to misinterpretation and confusion, the King’s Fund has warned.

The health policy think-tank is calling on the NHS to make sure it is clear about the aims of different measures and the audiences at which they are targeted, and that indicators are fit for purpose. It is also urging the health service to raise the profile of data quality.

A discussion paper, ‘Getting the Measure of Quality’, says the NHS Next Stage Review heralded a shift from an NHS focused on targets and waiting times to one focused on experiences and outcomes.

The local benchmarking scheme, Quality Accounts, the Commissioning for Quality and Innovation scheme (CQIN), and the Indicators for Quality Improvement that are being developed by the Information Centre all support this shift.

The King’s Fund says measuring for quality is not new and describes the Quality and Outcomes Framework (QoF) for GPs as “arguably one of the most comprehensive quality measurement systems for performance assessment in the world.”

However, the report says the NHS needs to learn lessons from other countries and avoid common pitfalls.

It calls for guidance on the appropriate interpretation of and caveats to the use of any indicators, to minimise the risk of misinterpretation and confusion amongst patients and NHS organisations when reporting data publicly.

The paper adds: “Patients and the public could be misled and alarmed by league tables that need cautious interpretation, and NHS staff could become demoralised and disaffected by adverse publicity that they may perceive to be unwarranted if there is uncertainty or disagreement around the data.”

Veena Raleigh, lead author and senior fellow at the King’s Fund, said it was important to remember that meeting performance indicators was not necessarily the same as good care for the individual patient.

She added: “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.”

The paper says organisations need the skills, engagement and capacity to develop indicators, collect and analyse data and draw appropriate conclusions from it.

It also argues that the NHS must make the best use of existing data sources as developing new data sources, although important, can be costly and take several years.

It adds: “There is a need for a longer-term strategy for information developments that maximise IT opportunities, including for measuring aspects of quality currently considered ‘too hard to measure’.”

The King’s Fund 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.

Link: Getting the Measure of Quality