Davies H T, Lampel J
Department of Management, University of St Andrews, Scotland, UK.
Qual Health Care. 1998 Sep;7(3):159-62. doi: 10.1136/qshc.7.3.159.
The 1980s and 90s have seen the proliferation of all forms of performance indicators as part of attempts to command and control health services. The latest area to receive attention is health outcomes. Published league tables of mortality and other health outcomes have been available in the United States for some time and in Scotland since the early 1990s; they have now been developed for England and Wales. Publication of these data has proceeded despite warnings as to their limited meaningfulness and usefulness. The time has come to ask whether the remedy is worse than the malady: are published health outcomes contributing to quality efforts or subverting more constructive approaches? This paper argues that attempts to force improvements through publishing health outcomes can be counterproductive, and outlines an alternative approach which involves fostering greater trust in professionalism as a basis for quality enhancements.
20世纪80年代和90年代见证了各种形式的绩效指标大量涌现，这是试图对医疗服务进行指挥和控制的一部分。最近受到关注的领域是健康结果。关于死亡率和其他健康结果的已公布排行榜在美国已经存在了一段时间，自20世纪90年代初以来在苏格兰也有；现在英格兰和威尔士也编制了此类排行榜。尽管有人警告这些数据的意义和用途有限，但这些数据仍在公布。现在是时候问问这种补救措施是否比疾病本身更糟糕了：公布的健康结果是有助于提高质量，还是在破坏更具建设性的方法？本文认为，通过公布健康结果来迫使改进的尝试可能会适得其反，并概述了一种替代方法，即增强对专业精神的信任，以此作为提高质量的基础。
