How easy is it to measure quality in medicine?

Interesting commentary here.on this subject.  There is a lot of emphasis now in health care going forward on quality, quality metrics, quality performance, etc. without much specifics on what exactly that means.

I come from a background that when I trained in orthopedic surgery and sports medicine, we were considered to have the highest quality of care in the world.  I know this because we trained  people from all over the world who want to come here and learn what we knew and take that back to their country.  China, Saudi Arabia, Greece, Germany, England, Turkey, Russia, Mexico, Columbia, Peru, Japan, Yugoslavia, Spain, Norway, Nigeria, South Africa are but some of the countries I remember training people from.  Quality in this country in health care was never considered a problem.   Cost and maybe access to care, but not quality.