title: The meaning of quality work from the general practitioner's perspective: an interview study.
abstract: BACKGROUND
  The quality of health care and its costs have been a subject of considerable attention and lively discussion. Various methods have been introduced to measure, assess, and improve the quality of health care. Many professionals in health care have criticized quality work and its methods as being unsuitable for health care. The aim of the study was to obtain a deeper understanding of the meaning of quality work from the general practitioner's perspective.
  
  
  METHODS
  Fourteen general practitioners, seven women and seven men, were interviewed with the aid of a semi-structured interview guide about their experience of quality work. The interviews were tape-recorded and transcribed verbatim. Data collection and analysis were guided by a phenomenological approach intended to capture the essence of the statements.
  
  
  RESULTS
  Two fundamentally different ways to view quality work emerged from the statements: A pronounced top-down perspective with elements of control, and an intra-profession or bottom-up perspective. From the top-down perspective, quality work was described as something that infringes professional freedom. From the bottom-up perspective the statements described quality work as a self-evident duty and as a professional attitude to the medical vocation, guided by the principles of medical ethics. Follow-up with a bottom-up approach is best done in internal processes, with the profession itself designing structures and methods based on its own needs.
  
  
  CONCLUSIONS
  The study indicates that general practitioners view internal follow-up as a professional obligation but external control as an imposition. This opposition entails a difficulty in achieving systematism in follow-up and quality work in health care. If the statutory standards for systematic quality work are to gain a real foothold, they must be packaged in such a way that general practitioners feel that both perspectives can be reconciled.
authors.affiliation: Blekinge R&D Unit, Erik Dahlbergsv, 30, SE-374 37 Karlshamn, Sweden. eva-lena.strandberg@ltblekinge.se
authors.forename: Eva Lena
authors.initials: EL
authors.lastname: Strandberg
authors.forename: Ingvar
authors.initials: I
authors.lastname: Ovhed
authors.forename: Anders
authors.initials: A
authors.lastname: Håkansson
authors.forename: Margareta
authors.initials: M
authors.lastname: Troein
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005194:Family Practice / Q000941:ethics / Q000331:legislation & jurisprudence / Q000592:standards*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D028681:Moral Obligations; D010821:Physicians, Family / Q000523:psychology*; D017064:Process Assessment, Health Care; D017009:Professional Autonomy; D011369:Professional-Patient Relations; D019984:Quality Indicators, Health Care; D012926:Social Control, Formal; D011795:Surveys and Questionnaires; D013548:Sweden