Cornerstones of Health Care in the Nineties: key constituencies debate propositions for collaborating in the quality revolution.
Dennis S. O'Leary, MD, president, Joint Commission, Oakbrook Terrace, Illinois, summarized the main points of the conference and made several recommendations for future efforts in quality improvement. One major issue is the lack of a common lexicon for words such as "quality," "standard," and "criterion" and for phrases such as "patient outcomes," "process measures," and "outcome measures." The broad spectra of quality improvement tools, such as standards or guidelines, performance measures, and large, new data bases, are complex and still undergoing evaluation. These tools are best if used together, if their full benefit is to be realized. "While a substantial amount of reliable data exists right now, we don't have the tools to get underneath the data and understand what they are already capable of telling us," Dr O'Leary asserted. There seems to be a continuing "comfort level" with structural standards and measures such as board certification, education, training, etc. "Quite clearly," he noted, "the discomforts of the future are likely to revolve around being willing to acknowledge good performance without requiring that the performer have various tickets as proof of competence." Dr O'Leary found general agreement that changing physicians' behavior will be difficult unless something is done about the professional liability climate. The concepts of total quality management (TQM) and CQI have arrived in health care, reported Dr O'Leary. "We are well reminded that those large industries where TQM and CQI are being applied are the same people who are buying health care from the provider community," he observed.(ABSTRACT TRUNCATED AT 250 WORDS)
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D006302:Health Services Research; D007373:Interinstitutional Relations; D011787:Quality of Health Care / Q000458:organization & administration*; D014481:United States