Quality assessment in health.

Abstract

Concern about the quality of care must be as old as medicine itself. But an honest concern about quality, however genuine, is not the same as methodical assessment based on reliable evidence. Still less is it quality control, which implies compliance with predetermined standards, as in an industrial process.Among Educational accreditation for training purposes. The royal colleges, the nursing regulatory bodies, and their equivalents in other professions, all inspect the relevant departments, institutions, and services to satisfy themselves that training arrangements in them meet the (generally rather shadowy) standards that they require.The confidential inquiry into maternal deaths. Stemming back to the 1930s, the inquiry consists of a confidential report from the local obstetrician, through a regional assessor, to national assessors. The assessors comment on the causes of death, identifying those that were in their view avoidable. They do so to those concerned with the specific case and (preserving anonymity) they also make a public report. It seems probable that by calling attention to avoidable causes, such as toxaemia, and by suggesting remedial measures, the inquiry has contributed to the progressive reduction in maternal deaths and to the United Kingdom's relatively good international performance on this criterion. But that hypothesis cannot be proved. The confidential inquiry has been applauded as a method and has influenced the approach to (among other problems) perinatal deaths and anaesthetic deaths, though no other British audit is as thorough as this.Clinical

Public awareness and social acceptability of dental therapists

“…There is a role for both the Government and the profession to communicate the rationale for using skill-mix in terms of increasing effi ciency and access while maintaining its effectiveness and thus improving the service's quality overall. 23 Our qualitative data suggested that once the rationale for skill-mix is explained, views on the use of dental therapists were modifi ed. 28 Similar arguments could also be used by dentists solely working in the private sector, if effi ciency improvements are refl ected in patient charges to patients.…”

“…A similar fi nding was reported in the South Yorkshire study. Evaluation of health services increasingly emphasises the importance of user views, 22,23,[44][45][46] the most contemporary of which go beyond evaluating patient satisfaction with services experienced. The concepts of social acceptability 22 and social validity 24 require a broader assessment of the social desirability and appropriateness of a service and its outcomes.…”

“…For example, healthcare quality assurance requires a service's social acceptability and legitimacy be considered as a key part of service quality assessment. 22,23 Similarly, the psychology literature refers to the importance of assessing the social validity of healthcare interventions where the social acceptability of the goals, procedures and outcomes of treatment is assessed. [24][25][26] Conceptually this can be applied to services or professional groups such as DCPs.…”

Evaluation of an NHS practice-based minor oral surgery service

“…Maxwell identifi ed six dimensions: 32 effectiveness, effi ciency (value for money), equity (is the service fairly applied? ), social acceptability (is the service acceptable to patients and other stakeholders?…”

Quality of Publicly Available Physical Activity Apps: Review and Content Analysis (Preprint)

“…The concept of quality in health care is complex and multifaceted [20]. Maxwell [21] proposed six dimension of health care quality: accessibility (ease of access to all patient groups), relevance to the need of the community, effectiveness, equity (fairness in the distribution), acceptability, efficiency and economy (desired health outcomes at the lowest cost). On the other hand, Donabedian [22] proposed a different categorization and argued for three crucial elements that pertain to the quality of health care: structure (facilities and health care professionals available), process (actions by which health care is provided), outcomes (the results of the actions).…”