'Quality' is a term widely used not only within healthcare but throughout society, with numerous references to the quality of care, commissioning, the use of the primary care 'Quality and Outcomes Framework', the regulation of quality of care and the impact of IT on quality and service user expectations of quality in this book alone. However, the study and development of quality is often hampered by lack of clarity of definition. Diverse meanings of the term make it both a 'seductive and slippery philosophy of management' (Wilkinson and Willmott 1995).
Within the healthcare field, the dominance of the medical profession with its own perspective on quality means that 'quality has become a battleground on which professions compete for ownership and definition of quality' (0vretveit 1997). The medical profession has traditionally 'owned' quality and utilised its own professional approaches to assuring and regulating it. The rise of quality improvement as something that involves more than the clinical professions has therefore led to 'the quality movement being equated with a change in power or a bid for power by managers within European health care systems' (0vretveit 1997).
One early pioneer of healthcare quality was Donabedian (1966) whose research and writings were important foundation for other developments, although some would argue that healthcare quality has been an issue since Florence Nightingale's time (Stiles and Mick 1994). Definitions of quality in healthcare abound (Reeves and Bednar 1994), and as the concept has been formalised within the healthcare field, a suite of healthcare-related definitions and 'dimensions of quality' have developed (see Table 26.1).
Quality can be viewed from various perspectives, and whilst patients may not feel qualified to judge the technical quality of healthcare 'they assess their healthcare by other dimensions which reflect what they personally value' (Kenagy et al. 1999). The concept of 'quality' outside healthcare was pioneered by Shewhart and his work on statistical process