Modern Concepts of Quality and Risk

Abstract

This article is about the complex interplay between quality and risk in the context of care for older people in Scotland. We review relevant theoretical literature underpinning the concept of ‘quality’ and its relationship with ‘risk’ to discover a wide range of regulatory challenges related to issues such as an increasing number of older people; intense press scrutiny; private care home provision; and, healthcare professionals increasingly shifting focus from generic care needs towards a personalized approach focusing on the care needs of the ‘individual’. In this environment, risk control must be ‘negotiated’ against resultant impact on the quality of life for individuals. We relate the existing literature to the approach devised by the Care Commission for Scotland to enforce published government standards: the adoption of a modern risk-based approach to regulation involving the use of a risk assessment scoring tool to determine and justify the level of regulatory intervention; and the development of a quality assessment framework that articulates the existing government standards. We conclude that if regulation and quality assurance are to concern themselves more with risk, then this will best occur within the context of integration and simplification rather than increased complexity —; perhaps with a unified set of care principles and quality themes that make direct provision for the management of risk. While this is of specific relevance to the regulator in Scotland, the principles we discuss have application to other parts of the UK and to other countries that face similar challenges.