An Introduction to Quality Assurance in Health Care by Avedis Donabedian

By Avedis Donabedian

Avedis Donabedian's identify is synonymous with caliber of therapy. He unraveled the secret in the back of the concept that via defining it in transparent operational phrases and supplied designated blueprints for either its measurement(known as caliber evaluate) and its improvement(known as caliber assurance). Many earlier than him claimed that caliber could not be outlined in concrete target phrases. He proven that caliber is an attribte of a approach which he referred to as structure, a suite of prepared actions whihc he known as process, and an consequence which ends up from either. during this ebook Donabedian tells the entire tale of caliber evaluate and coverage in uncomplicated, transparent phrases. He defines the that means of caliber, explicates its elements, and offers transparent and systematic publications to its overview and enhancement. His type is lucid, succinct, systematic and but own, virtually conversational.

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There must be, for example, an organizational mechanism charged with the responsibility to monitor, and adequately supported with the needed resources. Various monitoring activities will be discernible, some routine and others occasional; some carried out by the centralized authority and others delegated. There will be well-defined avenues for communicating the findings to those responsible for taking action in response to these findings, it will be evident that appropriate action has been taken, and it will be known how effective any action has been.

These features are adjuncts to the desirable aspects of the patientpractitioner relationship and, like the latter, help make the experience of receiving health care either pleasant and rewarding or unpleasant and humiliating. Because I have put so much emphasis on the patient-practitioner relationship and the amenities of care, I should also mention some dangers of an over-reliance on these in judging the quality of care. One should be alert to the possibility that attractive surroundings and a pleasant "bedside manner" might cover up, or substitute for, deficiencies in technical care because it is expected that patients will readily appreciate and be gratified by the former but will be less likely to understand and ap- The Components of Quality in Health Care 21 preciate the latter, especially when the consequences or success or failure in technical care are delayed and responsibility for them obscured.

But even in such situations, what resources are available could be more effectively used if clinical and production efficiency were improved. This brings us to still another question. Are considerations of cost relevant to the definition of quality? Or, on the contrary, should quality be defined independently of cost considerations? In other words, is cost an ingredient in quality itself or is it simply the price at which quality is bought? On this point opinions differ; and it does not matter much what position one takes as long as cost and quality are assessed simultaneously.

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