Quality Management – a short introduction
History
In 1910 the American surgeon Ernest Amery Codman explained the "end result concept" to his friends and colleagues: Doctors should document the aim of their treatment and end result of their actions in order to learn from them.
His idea was to standardise surgical practice in hospitals and to ensure surgical competence by measuring the outcome of surgical treatments. For this purpose he developed an early classification of the clinical pictures and the causes of quality deficits ("imperfection").
At that time his demand for quality in healthcare was already a hazardous enterprise. Codman lost most of his medical friends and his position at the Massachusetts General Hospital, but about hundred years later hisoutcome-orientated approach became the basis of modern quality management.
Basics
Since 1960 many approaches and methods of quality management have bee developed in the USA and later exported to Europe.
In general, a distinction is made between inductive and deductive methods.
- Inductive method means external control by licence assessment, accreditation (JCAHO), ISO 9004 certification or other external comparisons. All these measures are well-known as "external quality assurance".
- Deductive method means the recognition of potential quality problems in clinical practice. The best-known methods of "internal quality assurance" include laboratory ring tests, quality standard groups, and evaluation studies.
Benchmarking combines the principles of internal and external quality management.
Quality Management
All these methods are reflected by the definition of quality management:
Quality management is a professional discipline providing a comprehensive theoretical framework and practicable instruments with which continuous assessment and improvement of care can be carried out in routine practice.
John Williamson, 1980
The evaluation concept is one of the basic methods of quality management:
- Evaluate the quality of medical care with comparable criteria, indicators and valid standards.
- Analyse the divergence between reality and desired standards.
- Compare the results with the desired standards.
- Determine whether the aim has been achieved.
- If these aims are not achieved, repeat the procedure until there is an acceptable improvement.
