[Quality assurance in Europe]

The development of quality assurance in Europe can be divided into three periods: "In the beginning", "half-way through", and "almost there". In the beginning, the early 1970s, Europeans became interested in the US's concern for quality assurance. Pioneering clinicians and health services researchers, a few politicians and managers failed to make quality assurance a going concern. Halfway through, during the 1980's the situation started to change. Health care costs started to rise, and critical voices gained strength. Health authorities, and perhaps more importantly, the clinicians were shocked to see the variation in performance revealed by studies. Awareness, and training programs produced a critical mass of people interested in quality of care. In 1989, we the almost there era started. Formal political will and professional commitment for quality assurance gave rise to routine programs supported by the administration in many health care institutions. Now, the patient's right to quality care is recognized. Many professional groups have adopted quality assurance, some feeling obliged by the professional ethos, others believing it to provide them with a competitive edge. Furthermore, the biomedical research programme of the European Community has given a high priority to research on quality of care. Five main factors seem to explain most of the change: ethics, safety, efficiency, system and economics.