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Quality: a view from the centre

There is no doubt that quality is a central issue in health care at present. Indeed it could be said that quality is at the heart of medical practice. The concept, however, is not new and can be viewed as a part of the long tradition of professional practice. Recently, targets and quantitative aspects have been introduced into the measurement of quality for example, in relation to immunisation formalising what has been until now a fairly subjective approach. From the centre it is a concept seen as basic to the continuing improvement of health care. It is also an issue which is part of professional development and education and is related to clinical audit, accreditation, standards, guidelines, and protocols. This paper will set the scene as viewed from the centre and place quality and standards in perspective. There are two broad themes. The first is to discuss the role of the doctor and other health professions in the delivery of high quality health care, and the second is to emphasise the role of the patient and the public in determining quality. This paper will, firstly, tackle the definition of quality and its implications. It will then set quality in the context both of health and health care. Finally, it will discuss some of the issues surrounding clinical standards. Though this paper will be relevant to all health care professionals, most of the specific issues will relate to doctors.