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Claiming that quality assurance in Europe is a growth industry, the paper looks at this development from three angles: Has quality assurance become a science? Is it being practised? And how can quality assurance be successfully introduced? The paper concludes that quality assurance cannot yet be considered ‐ nor does it need to become ‐ a science, meeting the usual criteria of a scientific discipline. In spite of this, quality assurance has to be based on sound scientific evidence. There are encouraging signs of this happening: while there is no long research tradition in quality assurance, the number of studies is increasing and their quality is improving. On positive action, the paper finds the situation brighter. There is both political will and professional acceptance. WHO's European member states have accepted as a part of their overall health for all policy a specific target which requests them to build effective mechanisms for ensuring quality of patient care. The increasing professional interest and political will have resulted, among other things, in laws, quality assurance programmes, training programmes, national societies and journals. Views on quality and quality assurance have broadened; consumer views are being accepted as part of quality; the outcomes of care are emphasised; quality assurance is being extended from hospitals to primary care and nursing homes, and from medical care to nursing care and physiotherapy. Based on lessons learned from the past experiences, the last section of the paper makes recommendations for the successful introduction of quality assurance. The importance of demonstrating a need, the involvement of all those concerned and the provision of feedback are emphasised.

Many countries are developing primary care collaborative memory clinics (PCCMCs) to address the rising challenge of dementia. Previous research suggests that quality assurance should be a foundational element of an integrated system of dementia care. The purpose of this paper is to understand physicians’ and specialists’ perspectives on such a system and identify barriers to its implementation.

The authors used interviews and a constructivist framework to understand the perspectives on a quality assurance framework for dementia care and barriers to its implementation from ten primary care and ten specialist physicians affiliated with PCCMCs.

Interviewees found that the framework reflects quality dementia care, though most could not relate quality assurance to clinical practice. Quality assurance was viewed as an imposition on practitioners rather than as a measure of system integration. Disparities in resources among providers were seen as barriers to quality care. Greater integration with specialists was seen as a potential quality improvement mechanism. Standardized electronic medical records were seen as important to support both quality assurance and clinical care.

This work identified several challenges to the implementation of a quality assurance framework to support an integrated system of dementia care. Clinicians require education to better understand quality assurance. Additional challenges include inadequate resources, a need for closer collaboration between specialists and PCCMCs, and a need for a standardized electronic medical record.

Greater health system integration is necessary to provide quality dementia care, and quality assurance could be considered a foundational element driving system integration.

Explores the theoretical context of quality and quality assurance in health care through a detailed review of the current literature. Outlines the definitions of quality and quality assurance. Identifies the two structural elements of quality assurance: quality assessment and quality improvement and control. Explores in some detail the elements of health care which are capable of assessment and the relationships between them. Finally, considers the mechanisms which can be used to improve health care if deficiencies are highlighted.

In the light of public concern and of strong policy emphasis on quality and safety in the nursing care of patients in hospital settings, this paper aims to focus on the factors affecting the adoption of innovative quality assurance technologies.

Two sets of complementary literature were mined for key themes. Next, new empirical insights were sought. Data gathering was conducted in three phases. The first involved contact with NHS Technology Hubs and other institutions which had insights into leading centres in quality assurance technologies. The second phase was a series of telephone interviews with lead nurses in those hospitals which were identified in the first phase as comprising the leading centres. The third phase comprised a series of face to face interviews with innovators and adopters of healthcare quality assurance technologies in five hospital trusts.

There were three main sets of findings. First, despite the strong policy push and the templates established at national level, there were significant variations in the nature and robustness of the quality assurance toolkits that were developed, adapted and adopted. Second, in most of the adopting cases there were important obstacles to the full adoption of the toolkits that were designed. Third, the extent and nature of the ambition of the developers varied dramatically – some wished to see their work impacting widely across the health service; others had a number of different reasons for wanting to restrict the impact of their work.

The general concerns about front‐line care and the various inquiries into care quality failures emphasise the need for improved and consistent care quality assurance methodologies and practice. The technology adoption literature gives only partial insight into the nature of the challenges; this paper offers specific insights into the factors inhibiting the full adoption of quality assurance technologies in ward‐based care.

Describes alternative approaches to quality assurance in nursing and traces the historical shift from one approach to the other; quality as inspection to quality as opportunity. Early proselytizing approaches were superseded by an emphasis on quantitative measurement and attempts at “objective” evaluation which involved the development of the generic audit. More recently, the move has been towards locally developed audit and standard setting.

CASPE Research and Brighton Health Authority have been working together to test a series of approaches to quality assurance in healthcare. In this paper, they give an account of the results of the quality assurance techniques used; discuss the key requirements for successful quality assurance in the NHS environment; and consider the need for systematic evaluation of quality assurance programmes.

It is proposed that two approaches to evaluation that are being used to evaluate a major quality assurance initiative in the field of mental health care should be incorporated into all quality assurance evaluations. The author′s own evaluative work has been centred on a quality assurance system known as QUARTZ which is currently being piloted in three health districts in the South‐East Thames region of England. The importance of evaluating quality assurance programmes is stressed and it is argued that two particular forms of evaluation, utilisation‐oriented evaluation and formative evaluation, are particularly useful in this respect. Health care quality assurance programmes are particularly important arenas for evaluators to examine, especially with their probable proliferation in the wake of the statutory requirements centred on 1991.

Argues that the economic integration of the EC′s 12 member nations into a single community and the elimination of barriers to free trade will not result in a single health‐care system. However, the closer relationships among the member nations and the members′ individual desires for competitive advantage in the new marketplace will, inevitably, lead to an interest in comparing health‐care systems along cost and quality dimensions. Without a common currency for quality assurance, such comparisons will be time consuming, costly and of questionable validity. Consensus must be achieved on the following: the essential elements in a database for health care quality assurance; common classification systems for key elements in the QA database; standardized conventions for coding practices to ensure data validity and reliability. Suggests an assessment of current practices in health data collection in the member nations; a pilot project to assess the feasibility of developing a common currency for quality assurance, and an EC‐wide symposium to discuss data comparability issues as next steps.

The theory and practice of Quality Assurance in Health is drawn from and involves many disciplines and professions. The dangers of imprecisions in the use of terms can lead to confusion. The glossary prepared by the author aims to provide a firm foundation of definition, thereby avoiding squabbles over semantics.

Examines how computers and quality assurance are being used to improve the quality of health care delivery. Traditional quality assurance methods have been limited in their ability to effectively manage the high volume of data generated by the health care process. Computers on the other hand are able to handle large volumes of data as well as monitor patient care activities in both the acute care and ambulatory care settings. Discusses the use of computers to collect and analyse patient data so that changes and problems can be identified. In addition, computer models for reminding physicians to order appropriate preventive health measures for their patients are presented. Concludes that the use of computers to augment quality improvement is essential if the quality of patient care and health promotion are to be improved.