Health care delivery update: Part 2. Banking on quality: the call for a quality reserve system

In the health policy arena, policy-makers listen when physicians use quality as their battle cry in promoting or opposing health care innovations. Physician-managers are being challenged to measure quality and determine whether it is appropriate to deviate from community standards or expert opinion in providing care. Their responsibility extends to shaping their organization's culture and values, strategic planning, technology acquisition, and clinical performance. The effort to ascertain what constitutes genuinely effective medicine would be furthered by construction of a national Quality Reserve System. Designed to help--not police--individuals and organizations, it could accept data on diagnoses, processes of care, and functional outcomes and then provide "depositors" with evaluations of the effectiveness of various diagnostic and therapeutic approaches, suggest improved processes, and report on the clinical performance of each organization.