Friday, January 02, 2009

Ian Kennedy really does think that Health Care Commission has improved quality of health care

Interview with Ian Kennedy in BMJ in which he defends use of health indicators. Measurement of quality is not easy and failure to recognise how indicators can create perverse incentives is not helpful. In fact, focus on indicators can paradoxically make quality worse.

For example, I've just looked at the first core standard in the safety domain in the Annual Health Check for mental health trusts. This is that trusts self certify that they have a system for learning from patient incidents. It doesn't matter how well the Trusts do this - just that they have a system. In fact, undertaking a root cause analysis is extremely difficult, often mistakes and misinterpretations are made leading to recommendations which are never fulfilled, even if they were appropriate.

People forget Kennedy upset the medical establishment when he gave the Reith lectures in 1980 "Unmasking medicine". He answered his critics. Medicine does need to be more patient centred. But creating a manageralism that fails to provide the organisational infrastructure to support doctors in the exercise of their responsibilities is not the way forward.

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