JOURNAL OF THE ROYAL SOCIETY OF MEDICINE

Quality is a fashionable concept in health care, but what it means or how to measure it is not always clear; when National Health Service (NHS) trusts were set up in the early 1 990s they seemed to see quality assurance as a branch of marketing, which, as one health authority GP advisor put it, 'assures us that the quality is excellent'. Fortunately, this fashion for advertising rhetoric (often at variance with reality) seems to have passed. More positively, quality is taken to mean ensuring that agreed standards are met by measuring the process and outcome of care. In this sense quality is closely related to audit, and is sometimes no more than 'accounting by counting'. This works best for clearly defined issues where the objectives are not in doubt; therefore attention to quality of care has usually focused on problems wher