Measuring health care quality

Quality has become a headline issue in American health care. The topic has drawn the attention of professional societies, purchaser groups, regulators, and patient advocacy organizations, and questions about quality are becoming, in one form or another, part of the daily life of the doctor. To the practitioner, schooled in self-discipline, high standards, and a striving toward excellence, this sudden storm concerning quality may seem bewildering. Is the quality of care really so threatened today? What new and burdensome forms of regulation and surveillance may result from the concerns of those who buy and use health care? Where doctors once have felt trusted, admired, and valued, will we now feel increasingly the suspicion, surveillance, and control of the society we seek to help? Constructive response to the concern about quality in health care requires an understanding of the sources of that concern, skills and techniques with which to study and improve the quality of our care, and, above all, a change in the attitudes of both professionals and patients from one dominated by fear to one dominated by jointly held values to achieve the best possible care for our community. (July 1988)