Lessons learned in institutionalization of quality assurance programs: an international perspective.

A sustainable quality assurance (QA) program depends on development of a QA structure, ongoing standard setting, routine monitoring, quality improvement activities and the development of a culture of quality. A review of QA implementation in five countries identifies some practical guidelines for successful institutionalization of QA. These experiences underscore the importance of organizational assessment and provide insight about the advantages and disadvantages of an initial QA assessment. Developing a methodology that is both standardized and flexible is stressed, as well as a training strategy that integrates classroom learning, coaching and application. Gradual development of QA structure, based closely on existing systems, is recommended. Issues relating to gaining and sustaining political support, dealing with personnel changes, using appropriate incentives and dissemination are also discussed. Finally, the definition and dimensions of quality are put forth as the foundation for a culture of quality, which develops as individuals and groups commit themselves to their quality ideal.