Creating an agenda for change. Quality assurance in mental health services

Quality assurance is traditionally viewed in terms of structure, process and outcome, but ignores the fact that they coexist in day-to-day practice. Many quality assurance initiatives are based on the belief that organisational systems can be periodically improved using external experts; this can lead to a disjointed approach and alienate staff. QUARTZ is a quality assurance programme for mental health services, and encourages a collaborative, problem-solving approach among staff. Ongoing evaluation is essential to facilitate long-term change.