Evaluating healthcare systems and services

Any jurisdiction needs to assess whether its healthcare system is performing well. There are many dimensions of evaluation, but a basic set includes saving life, relief of suffering, and treating patients with dignity: these may be monitored by statistics of mortality, quality of life, and patient experience. Sets of indicators can give a system-wide overview, and aspects of individual services can be evaluated by clinical audit. Confidential enquiries are useful for rare, serious events. Investigation may need to be followed by action, but the decision to act is never simple. New health systems can be evaluated by the standard research designs, but qualitative investigation is important.