After years of focusing on throughput and a narrow definition of efficiency, the National Health Service in England turned its attention to dealing with the poor and variable quality of care. A mechanism was established for delivering a coordinated effort to set standards (National Institute for Clinical Excellence; NICE) to monitor them, and an expectation that all staff would have a duty for quality (clinical governance). Although policy makers had not sufficiently thought through the new system before implementing it and several aspects (such as the performance assessment framework …