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"The problem, of course, is that no one can agree on how to measure quality. This might be an intriguing question to untangle, if it weren’t for the fact that the quality measurement field has long since left the starting gate. Despite a lack of agreement on how best to measure quality, metrics are being applied broadly, with concrete consequences for doctors, nurses, hospitals and patients."

Could someone explain to me what the author means when he says, "left the starting gate"?

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closed as general reference by Unreason, kiamlaluno, PLL, waiwai933 Aug 19 '12 at 4:50

This question is too basic; it can be definitively and permanently answered by a single link to a standard internet reference source designed specifically to find that type of information.If this question can be reworded to fit the rules in the help center, please edit the question.

up vote 3 down vote accepted

It's a reference to horse/dog racing. The author is saying that the field in question has been in development for a long time.

He seems to be implying that members of the field are entrenched in their methods, and therefore stubbornly applying their pet techniques to situations in which they are not the most appropriate tool, which is causing problems for doctors, etc.

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It's a reference to racing, particularly horse racing, with the implication being that nothing further can be done to change the positions of the racers except to let the race run its course. It's too late to change or to reduce the line-up, or to better prepare a racer for the course, or to modify the course itself.

In your example, I assume it's referring to the use of different metrics in hospitals. As it is, some hospitals have already made their choice on which metric to use, and this can have serious consequences if new staff joins the hospital accustomed to using a different one. Obviously, the medical community would prefer that there is one universal metric, but how does one choose which hospitals will need to change their operations? Unfortunately it's likely too costly, both in terms of economics and liability, and so the different standards must continue to compete (as a commenter pointed out, this race doesn't ever really end).

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Thank you for another great response. – Jon Aug 22 '11 at 16:31
-1 for different standards must continue to compete until the end of the race. The metaphor is a bad one anyway, in that there is nothing that can be meaningfully called "the end of the race", except the arbitrary declaring of a "winner". Which can be done at any stage. It's more a "beauty contest" than a race from start to finish line, so "starting gates" is the wrong image (and even if it was correct, it would normally be "starting blocks"). – FumbleFingers Aug 22 '11 at 17:01
Better? This is one of my first answers, thanks for the comment! – Hannele Aug 22 '11 at 17:23
Yes indeed! I've reversed my downvote to an upvote, because I like the fact that you've clearly explained the "true" meaning of the metaphor, and the meaning intended by the writer. Plus the caveat as to why it doesn't really fit the context perfectly. – FumbleFingers Aug 22 '11 at 17:36

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