title: Is quality in the eye of the beholder?
abstract: BACKGROUND
  Relatively ignored in the literature on quality improvement (QI) in health care is the question of who defines the issues in quality of care and decides how those issues will be addressed.
  
  
  METHODS
  In late 1992, 669 hospital administrators, quality assurance (QA) coordinators, physicians, and nurses in 72 hospitals in six states were surveyed by telephone. Respondents were asked to identify the most serious issue related to quality of care in their hospital.
  
  
  RESULTS
  Of all the respondents, hospital administrators were most likely to identify quality issues related to organizational/institutional issues. QA coordinators, most of whom had nursing backgrounds, were most likely to identify organizational and patient care issues. Physician responses were distributed approximately evenly across issues related to physicians, to the organization, and to patient care. Nurses were most likely to identify issues related to patient care and patient satisfaction.
  
  
  CONCLUSIONS
  The findings validate the viewpoint that "quality is in the eye of the beholder" and that the eye is conditioned by the discipline in which hospital staff have been trained and socialized. As total quality management and continuous quality improvement approaches are implemented, and participants from many disciplines are involved in QI, a wide range of issues that have both a direct and indirect effect on patient care are likely to be addressed.
  
  
  CONCLUSIONS
  The findings of this study suggest that surveys that specifically target certain disciplinary groups may yield important information about issues related to quality of care.
authors.affiliation: University of Minnesota, Institute for Health Services Research, School of Public Health, Minneapolis 55455-0381, USA.
authors.forename: A
authors.initials: A
authors.lastname: Sales
authors.forename: N
authors.initials: N
authors.lastname: Lurie
authors.forename: I
authors.initials: I
authors.lastname: Moscovice
authors.forename: J
authors.initials: J
authors.lastname: Goes
mesh_terms: D001291:Attitude of Health Personnel; D003625:Data Collection; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008505:Medical Staff, Hospital; D009741:Nursing Staff, Hospital; D010348:Patient Care Team / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D011787:Quality of Health Care / Q000592:standards*; D013689:Telephone; D017749:Total Quality Management; D014481:United States