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Quality versus variance: a plea for a different focus and terminology
1Professional Anesthesia Services, Pensacola, FL.
Physician Executive
|March 9, 1994
Summary
Early medical quality assurance programs focused on documentation, leading to physician mistrust due to rigid, poorly designed standards. This created paranoia about quality assurance processes that persists today.
Area of Science:
- Medical Practice
- Healthcare Quality Improvement
Background:
- Medical quality assurance (QA) systems developed without clear definitions of medical practice standards or outcomes.
- Early QA efforts concentrated on documenting patient care processes.
Purpose of the Study:
- To analyze the evolution and shortcomings of medical quality assurance programs.
- To understand the origins of physician skepticism towards QA initiatives.
Main Methods:
- Historical analysis of quality assurance program development in medicine.
- Examination of the impact of standardized metrics and physician accountability on QA effectiveness.
Main Results:
- Initial QA programs focused on documentation and evolved to using generic screens with set tolerances.
- Physicians perceived QA standards as poorly designed, rigid, and retrospectively applied, leading to feelings of being unfairly scrutinized.
- The system fostered mistrust between physicians and non-physician QA personnel.
Conclusions:
- Inadequacies in early quality assurance programs have resulted in persistent physician paranoia regarding QA processes.
- The use of outcome scores and practice patterns in credentialing further exacerbates this mistrust.