Scientific and methodological issues in quality assurance

Abstract

SynopsisThe framework for this chapter stems from the proposal that the basic steps of the quality cycle should be combined with the practical stages of the scientific method to form an extended quality cycle comprising nine steps. The scientific and methodological implications of each step are considered in turn. The discussion of the three steps relating to the development, dissemination and implementation of clinical standards is based on a recent review of rigorous evaluations of clinical guidelines. The discussion of the three steps relating to the comparison of clinical performance with agreed standards is based on the existing principles of medical research. The final step is concerned with the management of change. The chapter ends by applying the steps of the extended quality cycle to the topic of thrombolytic therapy after acute myocardial infarction. The resulting hypothetical quality assurance exercise appears simple and potentially very effective. We conclude that, if quality assurance is pursued with a combination of scientific rigour, imagination and persistence, it has the potential to bring substantial benefits to patients and health professionals.