Beyond metrics? Utilizing 'soft intelligence' for healthcare quality and safety

Graham P Martin, Lorna McKee, Mary Dixon-Woods

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119 Citations (Scopus)
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Formal metrics for monitoring the quality and safety of healthcare have a valuable role, but may not, by themselves, yield full insight into the range of fallibilities in organizations. 'Soft intelligence' is usefully understood as the processes and behaviours associated with seeking and interpreting soft data-of the kind that evade easy capture, straightforward classification and simple quantification-to produce forms of knowledge that can provide the basis for intervention. With the aim of examining current and potential practice in relation to soft intelligence, we conducted and analysed 107 in-depth qualitative interviews with senior leaders, including managers and clinicians, involved in healthcare quality and safety in the English National Health Service. We found that participants were in little doubt about the value of softer forms of data, especially for their role in revealing troubling issues that might be obscured by conventional metrics. Their struggles lay in how to access softer data and turn them into a useful form of knowing. Some of the dominant approaches they used risked replicating the limitations of hard, quantitative data. They relied on processes of aggregation and triangulation that prioritised reliability, or on instrumental use of soft data to animate the metrics. The unpredictable, untameable, spontaneous quality of soft data could be lost in efforts to systematize their collection and interpretation to render them more tractable. A more challenging but potentially rewarding approach involved processes and behaviours aimed at disrupting taken-for-granted assumptions about quality, safety, and organizational performance. This approach, which explicitly values the seeking out and the hearing of multiple voices, is consistent with conceptual frameworks of organizational sensemaking and dialogical understandings of knowledge. Using soft intelligence this way can be challenging and discomfiting, but may offer a critical defence against the complacency that can precede crisis.

Original languageEnglish
Pages (from-to)19-26
Number of pages8
JournalSocial Science & Medicine
Early online date31 Jul 2015
Publication statusPublished - Oct 2015

Bibliographical note

Copyright © 2015 The Authors. Published by Elsevier Ltd. All rights reserved.
We acknowledge with gratitude our colleagues on the wider study, especially Janet Willars, who undertook most of the interviews used in this article. We would also like to thank the study's participants, and three anonymous peer reviewers. We thank the United Kingdom Department of Health Policy Research Programme (grant number 0770017) for funding this research programme of which this study was a part. Mary Dixon-Woods’ contribution was supported by a Wellcome Trust Senior Investigator award (grant number WT097899MA). Graham Martin's contribution to writing up the paper was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands. The views and opinions expressed herein are those of the authors, and do not necessarily reflect those of the Policy Research Programme, the NHS, the NIHR, or the Department of Health.


  • patient safety
  • healthcare quality metrics
  • knowledge management
  • England


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