Bulletin April 2015 Number 170

There is a real problem here. Is quality measurable or not?

When I sat down to write this editorial, I thought I would begin by defining the term ‘quality’. Easy, eh?

Not so. Dictionary definitions vary, as follows:

• an inherently distinguishing characteristic

• a personal trait, especially a character trait

• superiority of kind

• degree or grade of excellence.

To mention only a few.

There is a real problem here. Is quality measurable or not? To look at these definitions you have

to wonder whether quality refers to something that is different from something else, or better than

something else.

Clearly it has to be the latter, as otherwise all the quality improvement activities that contributed to my revalidation last year might well have been a waste of time.

I am reminded of my days in laboratories when I undertook both qualitative and quantitative analyses, the former when I was trying to find out whether or not something was present, and the latter to find out how much there was of something else. So if something has quality, why should we want to measure it? Let’s park that one for the moment.

Quality is synonymous with ‘attribute’ and ‘property’. As scientists (with a small ‘s’, let’s not argue please) we should be comfortable with the notion that both these words imply that attributes and properties have measurable parameters.

Unfortunately, it seems we are stuck with the term ‘quality’ as something that rolls off the

tongue nicely, so we will just have to live with it. Aside from semantics, those of us who need to

revalidate need to demonstrate ongoing involvement with quality improvement activities.

The General Medical Council quotes examples that include evidence of effective participation in

clinical audit, review of clinical outcomes, case review or discussion, audit and monitoring of the effectiveness of a teaching programme, or evaluate the impact and effectiveness of a piece of health

policy or management practice.

This issue of the Bulletin is concerned with quality in all its forms, in terms of the quality of the results we are expected to provide for patients and colleagues, how we apply standards (one aspect of clinical effectiveness) and the quality of advice we provide to our colleagues, and indeed the nature of the service

we provide to our colleagues. Perhaps matters improve when you stick the word ‘control’ or ‘assurance’ after quality, as it then commits you to measurement and periodic review.

Pathology on these shores has a history of involvement in this, almost as far back as the origins of this College, and our professionally led system of quality surveillance is undergoing an overhaul following

the Pathology Quality Assurance Review.

Several years ago the BMJ published an article about the Gettysburg address reduced to a powerpoint

presentation, drawing attention to the loss of information when it is presented in a different medium. Similarly, the current trend for dashboards in healthcare as a way of presenting performance also risks sacrificing richness of information – woe betide you if you have a red box to your name.

The presentation of quality will not be immune from this approach – watch this space. Inevitably, this will involve issues of transparency, personal performance and the introduction of potential tensions into existing

procedures, particularly revalidation. There is no reason why we should be subject to this any less than other area of healthcare, whether or not people feel that it takes them out of their comfort zone. This will be a major challenge of my term as Vice-President.

Dr Lance Sandle

Guest Bulletin Editor

Vice-President for Professionalism