Quality development in health care in Greenland: facing unlikely odds

Health care in Greenland is historically founded on a fully tax-based system financed in large part by the Danish state. Administratively, the system was until 1992 under the Danish health authorities, with a concomitant lack of clarity concerning lines of communication in quality issues. Because of the enormous distance and communications problems, the individual districts were and continue to be run with a great deal of autonomy; and to this time the level of centralized data sources concerning qualitative aspects of the health care sector are extremely sparse. An attempt is being made to introduce a state-of-the-art centralized data collection and analysis function, with all that that entails in terms of system and personnel development. This system is described as a project, using an analysis of the official waiting-list database as a case study. The establishment and administration of the system is described. A cross-sectional analysis of the database is presented, illustrating issues of validity and reliability, as well as specifying the areas of system and personnel development necessary to make this system functional. The author's perception of the generalized implications of the lessons learned to date is presented.