One of the problems with "quality" is that defining it sometimes seems to be like nailing down fog: everyone has some vague sense of what they mean but a clear description is elusive. So what does 'quality' mean for health care in the UK?
According to the Oxford English Dictionary, quality is "the standard of something as measured against other things of a similar kind; the degree of excellence of something" or "general excellence of standard or level". The 'industry standard' definition is that in ISO 9000: "the degree to which a set of inherent characteristics fulfils requirements".
While these are drily accurate, they are not particularly inspiring for a doctor, nurse or health care manager. I think we can do better. After she read an analysis of Toyota's DNA when the company was at its height, an American nurse, Cindy Jimmerson RN, developed a health care equivalent of the 'Ideal' at the heart of Spear & Bowen's paper. I have tweaked it a little (see below), but I suggest this as what we should strive for:
* To deliver what the patient wants & needs, defect free**
* ...one by one, customized to each individual patient
* ...on demand, exactly as requested
* With an immediate response to problems or changes
* With no waste
* In an environment safe for patients, staff & clinicians: physically, emotionally & professionally
**: Jimmerson had only "what the patient needs": I have met enough patients who are clear about the treatment that they do or do not want to make me want to add the further clause. For example, a patient may want surgery for inoperable lung cancer: they may want it, but it is not appropriate; another patient may need surgery for a perfectly operable but decline clinical advice.
We should still aim to get it right (whatever 'it' is), when it should be done, without waste. And, of course, for any change, the acid test is: does it move us toward or away from the Ideal?
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