Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Fielden and Mountford (1) suggest that we should seize on a concept
of 'value' in our consideration of healthcare. They regard cost and
quality as too often two separate conversations, which rarely meet.
Since the Institute of Medicine's report Crossing the Quality Chasm
defined the domains of quality in 1990 (2) there have been many variations
of this categorization of the term. Most have included some consideration
of cost, often labelled as cost-effectiveness or efficiency, as one of
their constituent parts(3).
In promoting the worth of 'value' as a concept, they have rearranged
the terms in the quality equation, but not the meaning of the equation
itself.
We have learned from the myriad reorganisations and renamings of NHS
structures that changes in terminology lead to loss of understanding and
confusion.
We were just starting to get used to the concept of 'quality', and
the depth of its meaning. Now is not the time to change the language.
1. Fielden J, Mountford J. A chance to optimise "value" in the NHS.
BMJ. 2011;342.
2. Institute of Medicine. Crossing the Quality Chasm: A New Health
System for the 21st Century. Washington, D.C: National Academy Press;
2001.
3. Kelley E, Hurst J. Health Care Quality Indicators Project
Conceptual Framework Paper. Organisation for Economic Co-operation and
Development: Paris; 2006.
The value of rearranging the quality equation
Fielden and Mountford (1) suggest that we should seize on a concept
of 'value' in our consideration of healthcare. They regard cost and
quality as too often two separate conversations, which rarely meet.
Since the Institute of Medicine's report Crossing the Quality Chasm
defined the domains of quality in 1990 (2) there have been many variations
of this categorization of the term. Most have included some consideration
of cost, often labelled as cost-effectiveness or efficiency, as one of
their constituent parts(3).
In promoting the worth of 'value' as a concept, they have rearranged
the terms in the quality equation, but not the meaning of the equation
itself.
We have learned from the myriad reorganisations and renamings of NHS
structures that changes in terminology lead to loss of understanding and
confusion.
We were just starting to get used to the concept of 'quality', and
the depth of its meaning. Now is not the time to change the language.
1. Fielden J, Mountford J. A chance to optimise "value" in the NHS.
BMJ. 2011;342.
2. Institute of Medicine. Crossing the Quality Chasm: A New Health
System for the 21st Century. Washington, D.C: National Academy Press;
2001.
3. Kelley E, Hurst J. Health Care Quality Indicators Project
Conceptual Framework Paper. Organisation for Economic Co-operation and
Development: Paris; 2006.
Competing interests: No competing interests