The Definition of Quality and Approaches to Its Assessment
To assess the quality of medical care one must first unravel a mystery: the meaning of quality itself. Perhaps it is useful to begin with the obvious by saying that quality is a property that medical care can have in varying degrees. It follows that an assessment of quality is a judgment whether a specified instance of medical care has this property, and, if so, to what extent. What is by no means clear is whether quality is a single attribute, a class of functionally related attributes, or a heterogeneous assortment gathered into a bundle by established usage, administrative fiat, or personal preference. The definition and specification of attributes is, only part of the problem. The phenomena or objects to which these attributes pertain are also poorly defined. Given these ambiguities, it is no wonder that the quality of medical care has been perceived and defined in so many different ways. But these many variants are not a random assortment. There is an underlying conceptual structure that seems to embrace them all, revealing the sources of their similarities and the reasons for their differences.
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