No, we can judge quality, not measure it. You cannot measure something that has both objective and subjective components.

A reader wrote:

Tell us, please: since Onora O’Neill is such an unquestionable source of Truth, what solution does she suggest? Implicit quality review? Kudos, if that’s the case! (if only we could realign payment rules to support implicit review activities)

I doubt she supports a state of blissful ignorance or believes there are no deficiencies in the quality of care delivered to patients.

First, I recommend to this reader that he/she spend some time browsing and reading this blog. I have written extensively on this question. However, I can try once again.

The problem with assessing quality is the multidimensionality of quality. If we only measure that which one can easily measure, then we will have clear and logical negative externalities. Onora O’Neill argues (as a philosopher) that only expert professionsals can judge and evaluate a professional.

We know that performance measurement can distort physician practice. I have recently written about the many performance measurement problems that we have recently encountered.

So I ask the commenter to consider what the the parameters of quality? We need correct diagnoses. We need decision making under conditions of uncertainty – especially when evidence does not guide us. We need to have physicians who care for patients – explaining diagnoses, the rationale behind tests, the reason and need for lifestyle changes, and delivering bad news. I have not completely described quality. Can you measure all those things?

I do not believe that we can easily measure quality. First, I would like a payment system that encourages true quality – which takes time – rather than one that discourages thinking and quality. We need patient centered care rather than check-box care. We need to rediscover the caring in patient care.