The language of quality

Management theorists have developed a language which, they claim, can be used to evaluate many diverse practices, including practices in health care. This language embodies conceptualizations of practice and an approach to evaluation which treat the concept of quality as foundational and which have links with free market ideology. Despite an extensive literature which attempts to apply this language to various areas of life, its fundamental conceptual assumptions remain largely unexamined. Without adequate philosophical arguments in support of these assumptions, the value of this language and the validity of the approach to practice that it embodies are unproven. Its imposition in the absence of such arguments therefore represents a form of intellectual imperialism. To understand and develop adequate responses to this situation, it is necessary to look at the broad political picture which affects the nature of debates in specific areas of practice, such as the health service, and to question the dominant paradigm governing practical debate in contemporary society.