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Measuring quality in the therapeutic relationship—Part 1: objective approaches
  1. Trisha Greenhalgh1,
  2. Iona Heath2
  1. 1Queen Mary University of London, London, UK
  2. 2Royal College of General Practitioners, London, UK
  1. Correspondence to Trisha Greenhalgh, Professor of Primary Health Care and Director, Healthcare Innovation and Policy Unit, Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, Abernethy Building, 2 Newark Street, London E1 2AT, UK; p.greenhalgh{at}


Background The therapeutic relationship is complex. Any attempt to capture its quality in a score or metric must involve an element of reductionism. But policymakers increasingly ignore the unmeasured.

Aim To review the different concepts, theoretical models and empirical approaches which researchers have used to capture the relationship between practitioner and patient in terms of scales, categories and other objective metrics.

Method Drawing on the principles of meta-narrative systematic review (but without seeking an exhaustive inventory of every paper ever published), we considered different research traditions in terms of their respective philosophical assumptions, methodological strengths and limitations and empirical findings. We applied published quality criteria from each tradition to papers within that tradition.

Results Three main research approaches were oriented to producing objective data about the therapeutic relationship. These appeared to have emerged in different research traditions: patient satisfaction surveys (health services research), rate-your-relationship surveys (social psychology) and interaction analysis (cognitive psychology). Each emphasised a different dimension and produced a different perspective on quality.

Conclusions Objective metrics, when well designed, offer important insights into the therapeutic relationship, but its elusive essence remains imperfectly captured by the best of them.

  • Family medicine
  • general practice
  • quality of care
  • satisfaction

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  • Funding The King's Fund, 11-13 Cavendish Square, London, W1G 0AN.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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