What is adequate health care and how can quality of care be improved?

Attempts to improve patient care, its increasing cost and the aggressive malpractice environment have highlighted the need for standards of professional accountability. However, current measures of quality of care have mostly been met with skepticism by the medical community. These measures have been criticized for their uncertain validity and for focusing on secondary aspects of service that measure what is minimally acceptable. The objective of this essay is to review quality improvement methods that have been reported to be feasible, effective and acceptable by practicing physicians. The successful implementation of these methods seems to be related to their being nonintrusive, nonthreatening, and based on agreed upon standards of care. We believe that these three features are essential for a continuous quality improvement process in health care.