• efficiency;
  • mental health nursing;
  • outcome measures;
  • performance indicators;
  • quality assurance systems;
  • service quality

Quality in health care services is neither a simple nor an apolitical issue. Quality is a complex concept and how it is defined and measured has important consequences for services. The definition and measurement of service quality in health care has slipped from professional toward managerial control. Professionals such as nurses have an absolute concept of quality which is a part of their value system and based upon their training and experience. Managerial concepts of quality may be influenced by other organizational concerns such as the pursuit of efficiency. This paper outlines quality assurance systems in mental health nursing and the wider quality debate and argues that there may well be a trade-off between quality of service and efficiency. The moves toward outcome measures and performance indicators are also discussed and the argument forwarded that such a focus serves to exclude users and cloaks serious issues in service delivery. The argument of this paper is that evaluation of service quality needs to include users, and this could provide them with a platform for enhanced involvement in service planning.