KENNETH V. ISERSON, MD, MBA, FAAEM, FACEP
“Quality of care,” due to both its nebulous nature and its vital importance, has always been a much-discussed issue in medical ethics. For example, the Codes of Hammurabi, the Hippocratic writings, and other early medical treatises discuss quality of care.
Today, the changing goals and priorities within healthcare systems and the ongoing attempts to restructure local, state, and national health treatment delivery systems have increased the importance of defining the term “quality.”
Healthcare professionals commonly face conflicts between what they see as their obligations to their patients and the legal-economic constraints imposed upon them by legislators and healthcare administrators. Yet with increasing pressure for greater cost-containment, and with the advent of alternative healthcare delivery systems, it has become more difficult for healthcare professionals always to act in the best interests of their patients.
“Quality” refers to the essential character or nature of medical care. It is an elusive concept. The definition, in part, relies upon the perspective of those applying the term—healthcare providers, patients, or those who regulate the profession:
-Medical professionals often view quality of care as encompassing the best method of practicing medicine.However, they use their own “process standards,” sometimes called clinical protocols, as their true yardstick.
-Patients view quality medical care as including appropriate, rapid, and caring treatment—at a low cost.
-Regulators increasingly see quality care as the delivery of measurably improved outcomes using limited resources.
Each of these perspectives has some validity.