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Accreditation and Quality Assurance

, Volume 9, Issue 1–2, pp 92–95 | Cite as

Understanding the quality concept in health care

  • P. P. M. HartelohEmail author
Discussion Forum

Abstract

During the past three decades there has been an intense debate on the quality of health care. Errors in medicine, practice variations, competence of physicians, scarcity and lack of resources have all been reasons for discussing the quality of care. A clear definition of quality should explain the nature of the debate, improve uniformity of speech and facilitate meaningful actions such as quality assurance or quality improvement. However, in due course many different definitions have been proposed and principles of quality assurance in health care have been frequently questioned, because of their industrial nature. It raises questions on our understanding of quality in health care. In this paper, we (i) explore the nature of the quality concept, (ii) explain its meaning by Wittgenstein's theory on rule-following, and (iii) argue for understanding medical care as a reflexive practice, in order to integrate the meaning of quality in medical care.

Keywords

Quality Assurance Inherent Characteristic Health Care Organisation Caesarean Section Rate Normative Frame 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Harvey G (1996) Quality in health care: traditions, influences and future directions. Int J Quality in Health Care 8:341–350CrossRefGoogle Scholar
  2. 2.
    Steffen GE (1988) Quality medical care: a definition. JAMA 260:56–61CrossRefPubMedGoogle Scholar
  3. 3.
    Harris-Wehling J (1990) Defining quality of care. In: Lohr KN (ed) Medicare: a strategy for quality assurance, vol 1. National Academy Press, Washington D.C., pp 116–139Google Scholar
  4. 4.
    Campbell SM, Buetow RSA (2000) Defining quality of care. Soc Sci Med 51:1611–1625CrossRefPubMedGoogle Scholar
  5. 5.
    Blumenthal D (1996) Quality of care—what is it? N Engl J Med 335:891–893Google Scholar
  6. 6.
    Blumenthal D (1996) The origins of the quality-of-care debate. N Engl J Med 335:1146–1149CrossRefPubMedGoogle Scholar
  7. 7.
    Triadou P (2002) Quality and quantity within medicine. Accred Qual Assur 7:507–511CrossRefGoogle Scholar
  8. 8.
    Millenson ML (1997) Demanding medical excellence. Doctors and accountability in the information age. University of Chicago Press, ChicagoGoogle Scholar
  9. 9.
    Plato (1987) Theaetetus. Penguin, London, 182aGoogle Scholar
  10. 10.
    Plutarchus. (1986) Adv Col 1110F-1111A (DK 68A57). In: Die Vorsokratiker II. Reclam, Stuttgart, p 281Google Scholar
  11. 11.
    Copi IM (1986) Introduction to logic, 7th edn. Macmillan, New York, p 130Google Scholar
  12. 12.
    Munchow OB (1986) The term 'quality'. Quality Rev Bull 12:310Google Scholar
  13. 13.
    Wittgenstein L (1958) Philosophical investigations. Blackwell, OxfordGoogle Scholar
  14. 14.
    Harteloh PPM, Verheggen FWSM (1994) Quality assurance in health care. From a traditional towards a modern approach. Health Policy 27:261–270PubMedGoogle Scholar
  15. 15.
    ISO 9004–2 (1991) Quality management and quality system elements—Part 2: Guidelines for services. ISO, GenevaGoogle Scholar
  16. 16.
    ISO 9000 (2000) Quality management systems—fundamentals and vocabulary. ISO, GenevaGoogle Scholar
  17. 17.
    Donabedian A (1980) Explorations in quality assessment and monitoring, vol 1. The definition of quality and approaches to its assessment. Health Administration Press, Ann Arbor, MichiganGoogle Scholar
  18. 18.
    Wulff HR (1986) Rational diagnosis and treatment. J Med Philos 11:123–134PubMedGoogle Scholar
  19. 19.
    Harteloh PPM (2003) Quality systems in health care: a sociotechnical approach. Health Policy 64:391–398CrossRefPubMedGoogle Scholar
  20. 20.
    Pendleton D, King J (2002) Values and leadership. BMJ 325:1352–5CrossRefPubMedGoogle Scholar
  21. 21.
    Berwick DM (1994) Eleven worthy aims for clinical leadership of health system reform. JAMA 272:797–802CrossRefPubMedGoogle Scholar
  22. 22.
    Committee on Quality in Health Care in America (2001) Crossing the quality chasm: a new health system for the 21st century. National Academy Press, WashingtonGoogle Scholar
  23. 23.
    Beauchamp TL, Childress JF (1983) Principles of biomedical ethics, 2nd edn. New YorkGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Department of Health Policy and ManagementErasmus MC/ Erasmus UniversityRotterdamThe Netherlands

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