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institutions, and revised hospital accreditation guidelines have sharpened the clinical and administrative hospital
staffs’ concern for evaluating the quality of care they provide. Evaluation is particularly important for detecting and rectifying, as early as possible, any adverse effects caused by recent cost-containment efforts.Physicians have traditionally enjoyed a great deal of autonomy in their practices,’ and the mechanisms for monitoring and assuring the quality of the care they provide in hospital have tended to be based on internal peer review.23 Time, however, has torn away much of the curtain of professional mystique. The growth of the consumer movement, governmental concerns about spi-ralling health care costs, public policy debates over health care priorities, financial restraints on health care

4Physicians and administrators now must face the challenge of establishing comprehensive and vigorous
systems of quality assurance and learn to avoid the traps that impede implementation of such systems. Much of
the insecurity and frustration that they feel can be avoided by remembering that quality assurance is a very
simple process that deals with finding problems and fixing them.

5 Implementation of a quality assurance program does not imply that some unknown authority is about to challenge physicians or administrators on how they practise their professions, and the program should not be regarded as yet another bureaucratic measure that diverts time and energy from the important business of caring for patients; quality assurance is simply the systematization, documentation and assessment of certain evaluative activities and should be seen as a
stimulus that makes these activities as rigorous and pertinent as possible. Indeed, it may be argued that a hospital’s attention to quality assurance is one indicator of the overall quality of care provided by the hospital.

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Thus, a comprehensive definition of quality health care would be as follows:
6 The optimal achievable result for each patient, the avoidance of physician-induced (iatrogenic) complications, and attention to patient and family needs in a manner that is both cost effective and reasonably documented.
The success of any quality assurance program depends almost entirely on the commitment and interest of the administrators, nurses, paramedical staff and physicians. A lack of commitment is far more injurious to the program than any technical flaws in the evaluative process. Coordinators of quality assurance programs must select a strategy that inspires interest and commitment without burdening clinical and administrative staff with an activity they neither understand nor believe in.
As Affeldt and associates7 have stated: “Just as a good manager monitors the status of the budget or staffing
levels routinely to assure a cost-effective department, the quality of the care in each department and in the
hospital [as a whole] should be monitored routinely with equivalent rigour.”

Recognition and consideration of five basic issues can do much to improve hospital-based quality assurance activities.

1. The temptation to try to buy an easy way out Hospital leaders – administrators and heads of clinical divisions or departments – must invest time and effort to learn the principles and practice of quality assurance. The installation of “canned” quality assurance packages is no substitute for leaders’ becoming intimately involved in the development of quality assurance ideas and activities.
2. The needfor a “utilization-focused” approach Acquiring information is no problem, but acquiring information that will actually help to resolve a problem is the sine qua non of an effective evaluation system.

It iS essential that a quality assurance program assure the relevance and utility of the results of the evaluation – the so-called utilization-focused approach.
8To assure the program’s utility, the coordinator of a quality assurance program must expend considerable
energy in helping the key decision makers and information users, identify and sharpen relevant questions.
9 Those who are most likely to be affected by the results of an evaluation must work together to define the issues and determine how they might best be resolved.

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