IS QUALITY IN THE EYE OF THE BEHOLDER

Background: Relatively ignored in the literature on quality improvemen t (QI) in health care is the question of who defines the issues in qua lity of care and decides how those issues will be addresses. Methods: In late 1992, 669 hospital administrators, quality assurance (QA) coor dinators, physicians, and nurses in 72 hospitals in six states were su rveyed by telephone. Respondents were asked to identify the most serio us issue related to quality of care in their hospital. Results: Of all the respondents, hospital administrators were most likely to identify quality issues related to organization/institutional issues. QA coord inators, mos of whom had nursing backgrounds, were most likely to iden tify organizational and patient care issues. Physician responses were distributed approximately evenly across issues related to physicians, to the organization, and to patient care. Nurses were most likely, to Identify issues related to patient care and patient satisfaction. Disc ussion: The findings validate the viewpoint that ''quality is in the e ye of the beholder'' and that the eye is conditioned by the discipline in which hospital staff have been trained and socialized. As total qu ality management and continuous quality improvement approaches are imp lemented, and participants from many disciplines are involved in QI, a wide range of issues that have both a direct and indirect effect on p atient care are likely to be addressed. Conclusion: The findings of th is study suggest that surveys kat Specifically target certain discipli nary groups may yield important information about issues related to qu ality of care.