Final Report > Chapter 6: Quality, Standards and Information > Other initiatives concerned with quality

Other initiatives concerned with quality

Quality assurance

16 During the 1980s, at the same time that ideas and the practice of medical audit were coming to prominence, other ideas about `quality assurance', [9] began to have an impact in the NHS. One significant influence was the influx of senior managers from outside the NHS, following the introduction in the mid-1980s of general management. In 1989 a survey of quality assurance initiatives in the NHS identified 1,478 initiatives in 116 districts. The growth of such initiatives was said to have reached `epidemic proportions'. [10]

17 Few if any of these initiatives, however, addressed quality in terms of professional competence or impinged on the exercise of clinical judgment. Most, to different degrees, borrowed and built on ideas from the quality assurance movement in industry. Involvement was voluntary and their success was limited. In a given hospital several initiatives were often pursued independently, but in parallel. Often initiatives were seen as the special preserve of nurses, or of a particularly innovative manager. For the most part, hospital doctors were not involved. The prevailing paradigm remained one in which it was left to the individual professional to define what was an acceptable standard of clinical care.

Footnotes

[9] We take the term `quality assurance' to mean methods used to maintain or enhance the quality of a service, using systematic assessment of performance against predetermined standards. It involved monitoring a service and introducing improvements

[10] Carr-Hill R, Dalley G. `Assessing the effectiveness of quality assurance'. `Journal of Management in Medicine', 1992; 6:10-18