ABSTRACT
It has become conventional wisdom for the evaluation of quality of health care to be divided up in to structure, process and outcome (Donobedian, 1980). This is a systems approach to the analysis of quality that appears to imply that there is agreement over how quality is defined by the major parties involved in the provision and use of health care. However, other writers have suggested that managers, clients and professionals might have differing and even conflicting perspectives about health service quality (Ovretveit, 1992): according to Grol et al. (1993), these three groups have differing priorities and place importance on different components. For example, a manager’s quality goal of cost containment may clash with a professional’s perspective of providing the best treatment possible. A number of authors, for example Best (1983) commenting on NHS performance indicators and Ranade (1994) on the Patient’s Charter, have made similar observations that the pursuit of one quality standard may impinge on the quest for another. However, the resultant standards which are in place and acted upon will depend on which of these different interest groups are most influential (Williamson, 1992). It has been suggested (Ranade, 1994) that despite the emergence of the so-called ‘new managerialism’, concepts of quality in health care are still determined largely by health professionals.
