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Understanding the quality concept in health care

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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.

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Notes

  1. 'What' could be a contemporary example of such a use: (i) what? (ii) what! (iii) 'what I wish to reflect on ...'

  2. An older text where we find the word stems from Demokritos (6th century BC). He speaks of atoms as: 'the void is filled with a moving substance, unfinite, undivisible and uniform, without quality (apoious) and not sensitive to any influence from without' [10].

  3. A theory on primary concepts also exemplifies a belief on the relationship between language and the world. According to Russell: 'Since all terms that are defined, are defined by means of other terms, it is clear that human knowledge must always be content to accept some terms as intelligible without definition in order to have a starting point for its definitions' [11]. Primary concepts are the atomary units of our conceptual apparatus.

  4. In the debate on health care, the quality concept sometimes still reveals itself as primary: 'Quality is an abstract concept, like honour or love. Like them, it is understood emotionally and irrationally; like them it is defined somewhat different by each individual, although members of a given culture generally agree on some basic characteristics of a definition; like them, it becomes incorporated into each individual's set of personal values' [12].

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Authors and Affiliations

  1. Department of Health Policy and Management, Erasmus MC/ Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands

    P. P. M. Harteloh

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  1. P. P. M. Harteloh
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Correspondence to P. P. M. Harteloh.

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Papers published in this section do not necessarily reflect the opinion of the Editors, the Editorial Board and the Publisher. Apart from exceptional circumstances, they are not submitted to the usual referee procedure and go essentially unaltered.

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Harteloh, P.P.M. Understanding the quality concept in health care. Accred Qual Assur 9, 92–95 (2004). https://doi.org/10.1007/s00769-003-0677-x

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