ABSTRACT
This chapter explores how quality of care is promoted across the National Health Service (NHS) as a whole. Managers in hospitals and health authorities are charged to monitor quality as part of clinical governance. Desired health outcomes may be different for managers, patients and clinicians. Managers are rightly concerned with efficiency, and seek to maximise the population health gain through best use of an inevitably limited budget. Clinicians are more focused on effectiveness, and want the treatment that works best for each of their patients. Patients dearly want treatment that works, and also place a high priority on how the treatment is delivered. The range of different desired outcomes above demonstrates the multidimensional nature of quality. Evaluation has been defined as ‘a process that attempts to determine as systematically and objectively as possible the relevance, effectiveness and impact of activities in the light of their objectives, e.g. evaluation of structure, process and outcome, clinical trials, quality of care’.
