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Argues that the economic integration of the EC′s 12 member nations into a single community and the elimination of barriers to free trade will not result in a single health‐care system. However, the closer relationships among the member nations and the members′ individual desires for competitive advantage in the new marketplace will, inevitably, lead to an interest in comparing health‐care systems along cost and quality dimensions. Without a common currency for quality assurance, such comparisons will be time consuming, costly and of questionable validity. Consensus must be achieved on the following: the essential elements in a database for health care quality assurance; common classification systems for key elements in the QA database; standardized conventions for coding practices to ensure data validity and reliability. Suggests an assessment of current practices in health data collection in the member nations; a pilot project to assess the feasibility of developing a common currency for quality assurance, and an EC‐wide symposium to discuss data comparability issues as next steps.

Fundamental hospital management reforms, enacted in 1990, focus on competition for National Health Service (NHS) contracts between public and private hospitals and the option of self‐governing trust status for NHS hospitals. The need to challenge the status quo in the NHS is discussed. Initiatives leading to self‐governance are reviewed. The Freeman Hospital′s model for the cultural change which is prerequisite to self‐governance is presented. The Freeman Hospital, Newcastle upon Tyne, a national pilot site selected by the NHS Management Executive to develop new management systems and practices, is among the first self‐governing hospital trusts in the NHS.