Complexities that Health Care Oversight Must Take into Account

The complexity and variability of the definitions given for the quality of care confuse physicians, patients and even specialists on this issue. Donabedian, a leader in the field of health care quality, has recognized that “several formulations are both possible and legitimate, depending on where we are located in the system of care and on what the nature and extent of our responsibilities are” (Donabedian, 1988). This wise view acknowledges that among professionals the types of interest in quality may vary. A conscientious physician in a busy practice may have a compelling interest in the quality of her or his daily interactions with patients, which is assessed essentially by immediate patient feedback. Similarly, nurses or other professionals want ongoing reassurance of the merits of their work. To such professionals, retrospective reviews months after the fact have secondary interest or importance. Their central focus is on the outcomes for particular patients, although the responses of groups have been of interest to professionals and have prompted many improvements in management.