QUALITY AND STANDARDS IN HEALTH-CARE

The chapter describes the professional and regulatory landmarks which have influenced the development of the quality movement in health care in the UK and the USA. They reflect the similarities and differences in the approach to quality which have evolved within the National Heal th Service in Britain when compared with a free market system of healt h care such as that in North America. A conceptual framework is used t o approach the definition and assessment of quality of health care, no ting in particular Donabedian's seminal triad of structure, process an d outcome as well as the outcomes movement and other theoretical appro aches to defining quality. The characteristics of criteria, standards, guidelines and protocols are described and the terminological problem s in this field are discussed. The use of standards for improving qual ity includes their application in clinical audit, for accreditation an d re-accreditation, in contracting for health services and in regulati on and inspection. There is a new and unfolding relationship between c linical standard setting and management. Concepts such as continuous q uality improvement and total quality management are challenging tradit ional assumptions about the need for a separation between professional , consumer and managerial approaches to improving quality, The Nationa l Health Service, following implementation of an internal market for p ublic health care provision in Britain, is well placed to absorb and s ynthesise the many differing philosophies in the health care quality m ovement to the benefit of both patients and the health professions ali ke.