The Struggle for Quality: the case of the National Health Service

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Abstract
Almost everybody, it seems, is currently in favour of improving the ‘quality’ of public services. However, analysis soon reveals that different groups define quality differently, adopt different approaches to its improvement and wield greater or lesser leverage in the struggle to determine which definitions, methods and measurements will be adopted in its pursuit. The NHS offers a particularly vivid example of the ‘politics of quality’. Close examination shows that the medical professionals have thus far been successful in protecting their own version of quality from outside scrutiny. The influence of patients in shaping quality systems has, by contrast, been slight. The main challenge to the traditional professional monopoly over judgements of quality is coming not from patients but from managers.

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