• Quality improvement
• Quality measurement
• Safety culture

For many readers, the story of the quality of care at Mid Staffordshire NHS Trust in the UK from 2005 to 2009 will need little introduction. The substandard care provided and the combination of circumstances that allowed such a situation to persist for several years have received widespread attention in the general media as well as in healthcare journals.1–4 At the heart of this coverage are the findings of two inquiries led by Sir Robert Francis QC—the first focusing on the quality of care provided at Stafford Hospital5 and the second on the role of a wider system of governance that failed to identify and remedy the problems over a sustained period.6

The inquiries have had a far-reaching impact within the UK. Some of the responses have been measured and considered; some less so. Media coverage has focused on the question of how such egregious failings could have gone unchecked for so long and on the extent to which they may be present in other NHS hospitals. The political impact has also been profound, with Mid Staffordshire characterised by the secretary of state for health as an extreme example of the ‘crisis in standards of care’ that pervades the health and social care system.7 In response to the second inquiry, the British government instigated two further reviews, one focusing on the quality of care at other hospitals with unexpectedly high adjusted mortality rates,8 and the other seeking to begin the task of translating the 290 recommendations offered by Francis into concrete plans for the Service.9

The texts of past inquiries show that Mid Staffordshire is not a unique case historically10; neither are healthcare failings confined to any particular health system in the present. While the scale and scope of poor-quality care at …