Where are the patients in the quality of health care?

Abstract

While the achievements of the Organisation for Economic Co-Operation and Development (OECD) Health Care Quality Indicators (HCQI) Project [1] are laudable and enable international comparisons of health care systems in terms of a particular type of quality, it is important to remember that quality is not value neutral. As Donabedian pointed out, 1981, explicit measures of quality carry with them the values of those who have defined the measures, and such measures are amenable to being used as instruments of control [2]. Who defines quality and who measures it are pivotal questions for those who engage in its pursuit. However, it would seem there is little consensus about the meaning or measurement of quality from the stakeholders involved in health. Of greater concern is that, despite the apparent plethora of attempts to gauge patient satisfaction with their health care experiences, there is a worrying downgrading of patients' perspective views of what they feel comprises quality health care. In most instances quality health care is assumed to occur with quality medical care [3, 4], including in Donabedian's seminal Structure/Process/Outcomes model [5], yet even physicians have a difficult time agreeing …