The emphasis on measurement in quality assurance: reasons and implications

Quality assurance initiatives and studies have focused more on the measurement of quality than on quality improvement and control. The bias toward measurement of current efforts is attributable to the marked preference for a competitive approach to quality assurance, in which measures play a central, triggering role. Reinforcing this bias is a long-standing belief that too little is known about measuring or even defining quality. This paper examines and evaluates these rationales. It concludes that a strong case can be made for pursuing a different overall strategy, one more balanced toward quality improvement and control and, within quality measurement itself, one less focused on the kinds of global outcome measures currently associated with the competitive approach to quality assurance.