The consumer: silent or intimate player in the quality revolution

Nurses are an agency's frontline representative; their centrality to the development of realistic and positive perceptions of care received must be acknowledged by the agency's management staff. Nurses must be recognized, not just as employees, but as entrepreneurs selling a product; the product of nursing care is a satisfied client with positive outcomes. The satisfied client is a major "marketer" for the health care facility and nursing services. It has been reported that satisfied customers will relate their satisfaction to four or five other people; dissatisfied customers will elaborate their dissatisfaction to 9 or 10 other people. As public policy on health care resource allocation is drafted, clients and third-party payors must collaborate with providers. Because public consumption will provide the principal advantage in the competitive health care industry, decisions regarding quality, cost, and access must be based on a national database of information (in universally understandable language), including an analysis of nursing and medical interventions, health outcomes, and health expenditures. The new paradigm shift toward total quality management recognizes that quality is no longer simply an attribute of a product or service; it also measures a relationship. A balanced relationship, reflecting trust between nurses, employers, underwriters, physicians, and the client, allows every player to define quality dimensions, make judgments, and contribute to the quality of care delivered and received. The consumer must be an intimate player in this scenario, or the health care system will continue to falter.