Determining the quality of a health system is a complex and challenging endeavour. The variety of perspectives needed to determine quality means that increasingly complex measurement frameworks are often employed. Providing the best possible health care has always been a priority for health system leaders, individual professions and individual professionals. But the importance and significance of measuring quality has increased since the evolution of quality-improvement methodologies for health-care quality standardisation in the 1990s.
Audit and feedback systems evolved into quality-control methods with the increased industrialisation of health systems. As the patient voice became increasingly important, with the rise in advocacy groups and patient-representative organisations, the focus on controlling the quality of services through a managerialist ideology was challenged. Broader, more inclusive, approaches to quality were embraced. Quality-improvement methodologies aim to adopt an inclusive approach to ongoing quality enhancement, ensuring that services are continuously developed and improved. This evolutionary context is important when considering the measurement methods that dominate health systems. To some extent, it could be argued that while health care cultures have shifted their focus from one of control to improvement, approaches to measurement continue to privilege standardised, quantifiable data and information that can be used for quality standardisation. Despite more than 30 years of developments in patient-centred and then person-centred care, the focus on quantitative measurement has continued to dominate, even though it does little to inform stakeholders about the person-centredness of a health system.