4 hour waiting times in A&E- a well intended measure of quality in our healthcare system that has become a managerial target and abused to the point of corruption. I agree with your implication that we as clinicians need to ensure clinical priority takes precedence over managerial priority and is not distorted by it. Outcomes and processes are familiar to us, but we are not good at getting involved in the balances to make sure our targets/ quality measurements dont become distortions to other parts of the service. Cheers.