ABSTRACT
This chapter initially adopts a narrow definition of what is meant by clinical quality, focusing primarily on the treatment and procedures which hospitals provide and their outcomes, ignoring the other aspects of quality of care which users may consider important. It explores the links between the three central elements – quality, cost and access – and the way that hospital services are configured, with the aim of identifying where they might run in conjunction and where they run in opposition. The chapter describes the scope, scale and other terms. The chapter distinguishes a number of different elements within the medical arguments for clustering specialties together and their relationship to the three central elements: clinical quality, cost and access. The hypothesis that scale of activity and quality of outcome are linked is often termed 'practice makes perfect', reflecting the common sense view that if people do more of a particular procedure, they get better at doing it.
