Author Affiliation: Centre for Quality of Care Research, Nijmegen University, Maastricht University, The Netherlands.
Physicians today are confronted with increasing demand to ensure and
improve care of their patients. A variety of approaches claim to provide solutions
to the problems of health care delivery. These approaches represent different
perspectives on optimal care and the best method for improving care. By summarizing
recent reviews and debates in this field, this article critically reflects
on the value of some of the approaches that have gained popularity during
the last decades: evidence-based medicine and clinical practice guidelines,
professional development, assessment and accountability, patient empowerment,
and total quality management. Evidence regarding the impact and feasibility
of the various approaches is mixed or simply lacking. In particular, the health
care community lacks an understanding of which approaches are most appropriate
for what types of improvement in what settings and of the determinants of
successful performance change. Given the complexity of improvement and change
in patient care, it is not realistic to expect that one approach can solve
all the problems in health care delivery. None of the popular models for improving
clinical performance appear to be superior. Therefore, bridges must be built
and models must be integrated to be truly effective.
Grol R. Improving the Quality of Medical Care: Building Bridges Among Professional Pride, Payer Profit, and Patient Satisfaction. JAMA. 2001;286(20):2578–2585. doi:10.1001/jama.286.20.2578
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