ARE HOSPITAL QUALITY IMPROVEMENT AND PUBLIC ACCOUNTABILITY COMPATIBLE

Background: The goals of public accountability and quality improvement are compatible in theory but not necessarily in practice. Both concep ts emphasize the customer. However, those working toward these two goa ls design systems with quite different roles and relationships between the providers and consumers of health care. Superficial interactions obstruct meaningful dialogue about how to build a better system meetin g both sets of goals. Issues: Current practices of public accountabili ty and quality improvement have fundamentally different paradigms conc erning the roles and responsibilities of those who provide and those w ho consume health care. Conclusions: There are at least three ways to improve the current relationship between public accountability and qua lity improvement. First, optimizing the design and performance of each effort would be an improvement since the goals are highly compatible. Neither ideal currently meets its own expectations, creating distrust among the proponents of each when reality falls short. Second, the tw o efforts could be coordinated through joint community-level planning and sharing. Finally and optimallly, the two concepts could be made pa rt of the same community-level cooperative system, an approach that of fers the greatest opportunity for achieving shared goals.