ABSTRACT
This chapter presents the evidence, from ad hoc studies of two main kinds: statistical studies of the relationship between hospital characteristics and clinical quality, and either of the quality of care achieved in particular instances or of the human and physical resources required to achieve a high level of clinical quality. Quality was poorer there were no differences in the rates of wound infection and only one General Practitioner (GP) patient had subsequently to be referred to a specialist, but GPs incorrectly diagnosed a higher proportion of malignant conditions as benign and inadequately excised 5 per cent of lesions. Within accident and emergency services and the related specialties of trauma and orthopaedics, the case for concentrating the most skilled staff arises in part from the requirements of offering a 24-hour service and the advantages of a larger workforce from which to draw to do so.
