It is some years since, in an article reviewing the state of quality assurance in Britain,' I argued that quality in health care is multidimensional. This was not a new proposition. Donabedian, for example, had recognised that patient satisfaction can often diverge from technical efficiency as perceived by the expert provider.2 As used to be said of one energetic surgeon, "His patients loved him and they died young." The two views of quality are clearly not identical: the methods for measuring them and the people best placed to judge them differ.
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R J Maxwell (1992) studied this question.
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