Quality in health care: traditions, influences and future directions

In tracing developments in health care quality, a number of different approaches to quality evaluation can be identified, differing in terms of the specific focus and means of achieving quality. This paper attempts to classify the development of quality in health care, drawing on experiences within the industrial quality movement. Three distinct models of quality evaluation are described, according to whether they define quality at an individual level, as an exercise in inspection, or as a method for continuous improvement. Developments in quality and audit in health care are explored in relation to the models and specific experiences within nursing and medicine are compared. The need to be aware of the history of quality within specific professional groups is highlighted, particularly within the context of future developments in health care quality and the growing focus on multi-professional collaboration.