Quality management in the NHS: the doctor's role--I.

Abstract

The doctor and the patient enter the examining room and the door is closed. For One of us (AE) has suggested that the seeds of poor service, fragmentation, and rising costs were planted in the very structure of the NHS.4 That structure has survived -because of the quality and dedication of the people who work in it and the underlying social commitment to equity, but it lacks strong incentives for the improvement of care and service. In fact, the incentives regarding improvement in the NHS have been perverse: better performance may be associated with higher workload but without a commensurate increase in resources. The widely criticised waiting lists for inpatient surgery are one result.Recent reforms in the NHS have been directed toward establishing structures and incentives that can encourage quality and efficiency.5 The reformers of the NHS intend to make it more sensitive to the needs of those who depend on it for service and care and to encourage providers of care to discover better ways to do their work. Under the new rules those who improve their performance would benefit from increased resources with which to handle their expanding share of the medical marketplace.The central idea is to create incentives for improvement by creating internal "markets" among components of the health care system. Under the new rules the district health authorities become selective purchasers of services that they were formerly obliged to "purchase" only from themselves. It now becomes the duty of the general manager of the district health authority to seek better deals for the patients for whom he has responsibility. With a fixed budget it is in both the patient's and the manager's interest for the authority to contract for services not only at lower prices but with better outcomes, as a poor outcome may necessitate further treatment at additional cost. When the general practitioner is the budget holder it is similarly in his or her interest to contract for the most cost effective care available.From the perspective of classical economic theory structural reforms based on a market model seem to offer a particularly attractive solution. They suppose improvement to occur as a result of reliable, natural laws of economics in which customers and providers find efficient solutions to their respective needs and constraints. With three basic components-freely available information on the quality of available goods and services, consistent and rational buyers, and competent producers-a market can unconsciously

Managed care organizations: Requirements and expectations for continuing education

“…5,6,7,13,14 However, needs relating the economics of managed care and working with the community received a lower response. [15][16][17] It seems that information regarding the economics of managed care is needed as it is fundamental to health professionals taking responsibility for coordinating various aspects of accountability of services and care.…”

Quality Management and Medical Education in Saudi Arabia

“…Terms such as quality control, quality assurance, quality management and total quality management are commonly used in industry for the purpose of perfecting products (Gale & Grant, 2010;Hassan, 2010;Berwick, 1992;NHS, 2010). Quality control is a set of activities or www.intechopen.com techniques whose purpose is to ensure that all quality requirements are being met.…”

“…This is particularly true in developing countries where conflicts among stakeholders are not uncommon in the absence of transformational leaderships (Al-Shehri, 2003;Al-Shehri & Khoja, 2009). The following four principles of quality management in health care mentioned by Berwick (1992) should be considered, bearing in mind the complexity and culture of medical education:…”

“…In the manufacturing industry, customers are not usually part of the process of production while in medical education and health care they are an integral part of it (Gale & Grant, 2010;Berwick, 1992). Many intrinsic and extrinsic factors interplay to influence structure, process and outcomes of medical education, and make it more complex than the manufacturing industry.…”

“…Quality management depends largely on customers' satisfaction (Berwick, 1992). In the manufacturing industry, customers are not usually part of the process of production while in medical education and health care they are an integral part of it (Gale & Grant, 2010;Berwick, 1992).…”