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> Sorry, I had my tongue in my cheek Matt. > I thought you might. However, it's actually not a bad one. Ray McGlone mentioned looking at the number of patients seen by each doctor. The trouble with this is that it encourages cherry picking (you can split up patients into ambulance patients, resus and minors, but it still encourages cherry picking from within each group). More of an issue though is that you'll perform "better" on this by seeing patients rather than by keeping an eye on what's going on in the department. The advantage of the 4 hour wait instead of this is that it shows who is performing best as a team leader. Sometimes that involves seeing a lot of the quick patients (either trolley or minors yourself); sometimes it involves seeing the most complex patients yourself; sometimes it involves taking on all the procedures; sometimes it involves sitting in triage; sometimes it involves keeping an eye on the whole department, giving a bit of advice on every patient by not being the main doctor to see any one of them. The nice thing about it is that it's a measure of outcome rather than process (so harder to game on) and that it picks up those who are best at performing at consultant level rather than at SHO level. Couple it to measures of quality of care possibly including mortality, unplanned returns, number of x-rays and investigations done (with high numbers being a bad thing), referral rates etc. and you've got a nice measure. Matt Dunn Did you know South Warwickshire General Hospitals NHS Trust is applying to become an NHS Foundation Trust? You can find out more about our application and/or apply for Membership at http://www.warwickhospital.nhs.uk/foundationtrust/default.aspx or by calling our Foundation Trust Office on free phone 0800 085 2471. This email has been scanned for viruses, however we are unable to accept responsibility for any damage caused by the contents. The opinions expressed in this email represent the views of the sender, not South Warwickshire General Hospitals NHS Trust nor NHS Warwickshire unless explicity stated. If you have received this email in error please notify the sender. The information contained in this email may be subject to public disclosure under the NHS Code of Openness or the Freedom of Information Act 2000. Unless the information is legally exempt from disclosure, the confidentiality of this e-mail and your reply cannot be guaranteed.