Different Perspectives on Health Care Quality: Is the Consensus Possible?
Different Perspectives on Health Care Quality: Is the Consensus Possible?

Summary/Abstract: For the success of health care organizations, accurate measurement of health care service quality is as important as understanding the nature of the service delivery system. Without a valid measure, it would be difficult to establish and implement appropriate tactics or strategies for service quality management. Experts have struggled for decades to formulate a concise, meaningful and generally applicable definition of the quality of health care. However, the complexity and variability of many definitions are very confusing even to experts. Patients, service providers and other parties involved in the process of health care service delivery, understand and describe service quality in different ways. Different perspectives on health care quality lead to different expectations and different methods of quality measurement. Patients tend to evaluate health care quality according to the responsiveness to their specific needs. Medicine has made remarkable advances over the past century and patients expect to get modern medical help, which would solve their health problems; medications that can cure a number of physical and psychological problems; surgery that can undo the inborn deficiencies and damage caused by accidents or diseases that until recently meant death or disability. Most patients define quality as efforts of physicians to do everything possible for a patient. Patients’ expectations about the health care system may differ from those of health care professionals and managers. For example, shorter visit lengths, which reduce the cost of providing ambulatory care, may have a negative effect on patients’ ability to participate in making choices about their care. On the other hand, patients cannot evaluate many technical aspects of health care quality. Physicians can provide a high level technical quality but still be rated low by patients because of the lack of humanity, responsiveness or satisfaction. For physicians and other health care providers measurement of quality has typically been driven by medical outcomes. However, outcomes indicative of quality may differ for a patient and physician. For example, although an oncologist may consider radiographically documented shrinkage of tumor size a desirable outcome, the patient may not care about tumor size and may rather consider improvement in health-related quality of life as the most desirable outcome. Health care administrators often use managerial input measures such as the average number of nursing hours required for an outpatient surgery. Considering all above mentioned, this article aims to reveal the similarities and differences between three competing perspectives on health care quality and to provide a way of integrating perceptions and needs of every group involved into one coherent approach to health care quality and its measurement.

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