title: Participation of National Medical Associations in quality improvement activities - International comparison and the Israeli case.
abstract: BACKGROUND
  Many countries have devoted considerable efforts in an attempt to improve the performance of their health care systems. National Medical Associations (NMAs), along with other stakeholders, play a part in the promotion of such activities. The purpose of this paper is to explore the nature and level of participation of NMAs in activities of quality improvement in medicine, with a specific emphasis on Israel.
  
  
  METHODS
  THE AUTHORS CONDUCTED A SURVEY AMONG NMAS AROUND THE WORLD INQUIRING AS TO THEIR INVOLVEMENT IN THREE CENTRAL ASPECTS OF QUALITY IMPROVEMENT: clinical guidelines, quality measurement and continuing medical education (CME). In addition, they conducted a review of the literature in order to gather more information and complete the data collected in the survey. The findings were processed and analyzed comparatively.
  
  
  RESULTS
  Most of the NMAs surveyed participate in quality improvement activities at least to some extent. NMAs' main involvement is in the regulation of CME and they are involved to a much lesser extent in the preparation of clinical guidelines and in quality measurement. In Israel, the Israeli Medical Association (IMA) has a dominant role in both the preparation of clinical guidelines and the regulation of CME credits.
  
  
  CONCLUSIONS
  It is possible that the expertise maintained by the profession, coupled with the organizational power of the NMA as a union, is viewed as beneficial for regulating educational activities in medicine such as CME. Conversely, the issuing of clinical guidelines is usually regarded as a typical scientific activity, and therefore often rests in the hands of professional medical societies. Quality measurement is regarded as a distinctive administrative tool and is usually found in the province of governments. Based on the typology that we introduced in our previous paper, we discovered that the extent of NMAs' involvement in quality improvement coincides with the mode of governance of the health care system.
  
  
  CONCLUSIONS
  The nature and level of participation of NMAs in activities of quality improvement varies widely. Collaboration of NMAs in this field with other stakeholders is not uncommon, and may contribute to the further development of quality improvement in medicine.
authors.affiliation: The Israeli Medical Association (IMA), Ramat Gan, Israel.
authors.forename: Baruch
authors.initials: B
authors.lastname: Levi
authors.affiliation: The Israeli Medical Association (IMA), Ramat Gan, Israel.
authors.forename: Malke
authors.initials: M
authors.lastname: Borow
authors.affiliation: The Israeli Medical Association (IMA), Ramat Gan, Israel.
authors.forename: Michelle
authors.initials: M
authors.lastname: Glekin