Quality systems in health care: a sociotechnical approach.

In this paper, we explore a sociotechnical approach to construct quality systems as an alternative to the traditional, ISO orientated approach. A sociotechnical approach is characterised as bottom-up, incremental, information technology facilitated and indicator driven. Its purpose is to ground quality assurance in medical practice and to provide meaning to those directly involved (patients, health care providers and medical professionals). Meaning depends on information. According to contemporary theory of meaning, facts become information on quality if the structure of data represents the structure of the quality concept. The structure of the quality concept is exemplified by definitions of the quality of care, most of them comparing actual properties of care with requirements, expectations, standards or guidelines. So, raw data or measurements have to be compared with a normative frame of reference in order to become information on the quality of care. Quality indicators conceptualise this theory of meaning. Therefore, constructing quality systems by developing quality indicators is important for the meaning of quality assurance in health care. It makes a system to a quality system and suits a sociotechnical approach by grounding the formal structure of the system in a social reality.