[Quality management in healthcare. Evaluation and improvement]

Quality in healthcare is a concept ultimately determined by the satisfaction of the patient, or more broadly stated, society's needs. Improvement in quality begins with the review of health care organizations, in the degree to which their current role and function can and do meet these needs. Recent trends in quality evaluation have been along the lines of patients satisfaction, as well as structure, process, and outcome oriented aspects of health care delivery. Quality entails not only the science of medicine itself, but also health care delivery, as well as social and individual concerns. In 1990, Japan Hospital Quality Assurance Society was founded. The secretariat is located at this department. Currently, more than 60 hospitals participate for the development of standards and survey to the hospitals. The quality improvement effort has slowly begun to put the concept into practice. The public's growing concern is directed toward holding healthcare organizations accountable for the services they provide. The healthcare field, in turn, is recognizing the needs and merit of voluntary commitment to quality, and are placing emphasis on identifying pressing society needs, and developing effective leadership. Moving the entire healthcare field in the direction of continuous quality improvement will be the key to the survival into the 21st century.