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Examines the extent to which quality assurance can be conceived as a rational endeavour, particularly in ethical terms. Examines the Weberian distinction between rationality as values as an “end in themselves” and values conceived in terms of a “means‐ends” distinction. While the emergence and existence of quality assurance can be viewed from either of these two perspectives, both entail a number of problems. Suggests that quality assurance, while appearing rational, fails at a crucial point for two reasons. First, while rationality is a relational concept, quality within the health service does not appear to function in such a manner; and second that quality assurance often neglects to evaluate its own activities. Claims that in both instances quality assurance acts more in terms of its functional role than in terms of its rationality.

The validity of an approach based on a quality system specification developed from BS5750 is considered, with reference to patient care activity in an out‐patient clinic at a general hospital. The quality systems specification is presented and the application of this system to the clinic and service departments is demonstrated.

The purpose of the paper is to examine commitment to quality assurance within health authorities.

The paper discusses approaches to achieving the requisite changes, including what to change and how to increase readiness for change; motives for change, where to start and prerequisites for change.

The paper finds that health authorities have a tendency to look at quality assurance as a professional luxury which deals with the subtleties of care rather than with its essence and that a strategy for change is needed.

The paper provides useful information on the development of quality assurance in health care.

One of the best results of Mr Griffiths' review of the UK National Health Service has been the increased attention being given to issues of quality. Not everyone agrees that the NHS can learn from management of the nation's retail trade, but many would acknowledge that a strong selling point for the Sainsbury's chain has been the consistent quality of its products. Quality also exists in the NHS, but not consistent quality. British Governments have recognised that one side of the equation for quality is a reasonable distribution of resources. Thus political parties have supported the Resource Allocation Working Party's formula for the distribution of NHS funds. Now the other side of the equation — improving the quality of care — has become a priority.

The purpose of the paper is to examine health care performance and accountability.

A strategic view of how quality assurance fits into other initiatives aimed at bringing about improvements in health care is offered in the paper.

The paper finds that the task of defining the way in which health care can be most efficiently and effectively delivered is the concern of all health care staff. Aims, should be clarified, performance criteria and measures agreed on and, wherever possible and appropriate standards set up. Management also has the responsibility of ensuring the consistency and coherence of the many different activities that contribute to the aim of good health care.

The paper provides useful information on the planning and performance of quality assurance in health care.

Steps take in Brighton Health District, with the help of CASPE Research (Clinical, Accountability, Service Planning and Evaluation), to build and maintain an approach to Quality Assurance (QA) are described. The system is based on co‐ordination of — and assistance to — voluntary peer review by clinicians and other professionals. The joint work has two aspects: first, implementation of microcomputer‐assisted trials of QA in a small number of clinical departments and professional/ non‐medical departments which aim to provide a productive environment for development of new indicators of the quality of care, and systems for their use, that are practical and economic for local use in the NHS. Second, the indicators are provisionally evaluated, and, where successful, related to service planning and resource management in the district. Indicators that are successful in Brighton will also be tested in other districts where CASPE is working.

The aims of a project to introduce customer relations standards to a District Health Authority are discussed. The manner in which staff guidelines are produced and staff action programmes are developed is examined and ways in which the corporate identity of the Health Authority may be changed by improvements in customer services are explored.

Describes different types of secondment in quality assurance. Addresses the social and occupational characteristics of the associated roles. Demonstrates that the benefits of secondment outweigh the limitations. Suggests that changes in the health care system are providing continuous scope for secondment and that this, therefore, should be taken advantage of.

Examines the relevance of the ISO 9000 standard within the health care, local government and education and training services sectors, as well as looking at the benefits of its implementation. Explains that organizations should be clear about what they expect from ISO 9000 beforehand and presents a list of dos and don′ts when implementing ISO 9000. Concludes that by concentrating on the feedback loop part of the standard and using a common sense approach to quality, most of ISO 9000 will fall into place.

In this article, the total quality programme in the Spanish health‐care system (1986‐1992) and the subsequent quality improvement steps that have led to definition and implementation of such an integrated framework, seeking a quality management system and patient safety, are discussed.