The National Health Service is in a period of extensive reform. Value for money is now a key objective. As a consequence, audit has become a widely used concept and activity. There has been some discussion in the literature of the use of tools for measurement in audit. These tools have mainly been used to measure outcomes. When they are used in isolation from other measures, an incomplete picture can result. Closs and Tierney ( 1 ) have noted that the current vogue for outcomes in NHS research has resulted in a less than complete evaluation of the phenomena under study, largely because the structures and processes are not being measured in parallel with the outcomes. Thomas and Bond ( 2 ) also noted that research has tended to concentrate on the outcomes of care, and that structures and processes are left assumed and undefined, thus making it impossible to link outcomes (favourable or unfavourable) to specific features of nursing input in particular. This has meant that the actual processes have tended to remain somewhat obscure.
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