Defining quality of care: mission impossible?

Finding the definition of quality has haunted mankind since the beginning of time. As far back as ancient Egypt and classical Greece, descriptions of quality show man's struggle with a concept that has not yet ended. Since the beginning of this century, descriptions of quality of health care have begun to take form in long lists of categories that make up the elements of quality. This catalog approach to defining quality has been replaced by the evaluative approach since Donabedian's conceptual studies in the 1960s. It has become commonplace now to define quality in evaluative terms: by comparing actual care with preset criteria, a judgement, and consequently a description or definition, can be obtained on real quality of care. In criteria and their derivatives one can document his intentions as to good quality; only after measurement and judgement can one be certain that quality has been described. A frequent source of concern is the erroneous belief that scientific research is synonymous with quality assessment. Research results form the basis of criteria for good care, and as such contribute to quality, but having obtained good research results does not imply that health care is properly and appropriately provided.