The last 10 years have seen an explosion of activity in the measurement of health care performance with the expenditure of huge resources on many different systems of data collection, analysis and reporting and the development of thousands of indicators. Large exercises have been undertaken by various quality organisations to develop, apply, and report the results of performance indicators. Examples include the National Quality Forum, the Joint Commission on Accreditation of Healthcare Organisations, the National Committee for Quality Assurance and, in the UK, the Healthcare Commission and Dr Foster. This has become a multi-million pound industry fuelled partly by increasing anxiety by society (especially its political representatives) about the variation in quality and safety of care—an anxiety heightened as the results of more measurements reveal even more problems. Whenever such an industry develops rapidly, it is useful to pause and reflect on the degree to which it is acting optimally and in the interests of society and health.

WHAT ARE THE IMPACTS?

As with many new technologies in which people invest, hoping it will solve problems simply, the experience has been disappointing. A catalogue of problems has been reported related to …