Editorial

Citation

Gillies, A. and Harrop, N. (2010), "Editorial", Clinical Governance: An International Journal, Vol. 15 No. 4. https://doi.org/10.1108/cgij.2010.24815daa.001

Editorial

Article Type: Editorial From: Clinical Governance: An International Journal, Volume 15, Issue 4

Clinical governance is concerned with ensuring that we all receive the best health care that we can. Part of the research that we report in this journal is about investigating what the “best” care actually is. Clinical governance is about comparing actual care against a standard by which it is judged. The standard that we use as our benchmark is not as static and unambiguous as we might think.

In Improving the Quality of Patient Care (Radcliffe Publishing, 2003) I argued that this standard was a multidimensional construct, and used earlier work by Garvin to develop such a model of quality. Such a model reflects the tensions between different dimensions of quality. The dimensions deemed to be most important in different national systems are influenced by culture and the broader political environment. Thus, in systems such as Canada and the UK, equity and fairness and access to essential services are pre-eminent. In the US, individual choice is much more important.

Changes in the external environment can shift the balance between these different dimensions. Thus, the reforms of the Obama administration have shifted the traditional balance in the US health care system, and the election of a new UK government has also shifted the balance between quality dimensions in the UK with a new emphasis on the patient view and less emphasis on conformance and uniformity.

However, shifts are often determined by external events and reaction to them, rather than proactive political choices. Thus, the economic downturn reduces our ability to pay for health care alongside other services. This prioritises the dimension of value for money, getting the maximum quality for the money spent.

The articles in this issue of CGIJ reflect different dimensions of quality in health care:

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  The articles by Turner et al. and Liyanage et al. reflect a view of quality, which may be represented as conformance to specification, with the specification defined by the best possible evidence, and quality assessed as the ability of care to conform to that supported by the best possible evidence. Turner et al.’s paper reflects the front end of this process, being concerned with guideline construction, whilst Liyanage et al.’s paper looks at compliance with guidelines.

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  The article by Birnbaum et al. reflects a patient based view of quality which prioritises the patient view, and seeks to facilitate informed choices by providing information in a patient accessible form.

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  Exton and Shreuder’s article reflects the long-term emphasis on access to care. Where access is poor, this can become the dominant quality dimension. Within a consumerist view of health care, there may become a point where this dimension is emphasised to the detriment of other dimensions, e.g. outcomes.

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  Ward et al.’s paper considers directly the conflict between two dimensions of care, in this case the search for economic efficiency by centralisation of services and the effectiveness of services as measured by outcomes.

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  Walshe et al.’s article looks at the impact of an educational intervention on the clinical dimension of quality. The investment in education represents an increased cost and therefore a reduction in the economic dimension of quality, however, this is counterbalanced by evidence of improved clinical outcomes.

The role of CGIJ is to publish high quality research covering the governance of all dimensions of the quality of health care. We shall seek to continue to ensure that our output reflects the multiple dimensions of quality and the tensions between them.

Alan Gillies, Nick Harrop