Monitoring: the eyes and ears of healthcare.

Society and the healthcare profession are bound by a contract, sealed with the healthcare practitioner's obligation to competence, integrity, and humaneness. Society confers privileges on the practitioner, who, in turn, accepts the obligations that society also imposes. Nevertheless, repeated assessments under all sorts of conditions have revealed unexpected, often serious defects in the quality of healthcare. The quality of healthcare depends on the performance of practitioners in a healthcare system--how much and how they improve health. The means used should be socially legitimate, acceptable to patients, and economically efficient. Some key elements and considerations in the performance of a healthcare system include patient care, population care, patient access to the system, outcomes, patient satisfaction, and the nature of the patient-practitioner encounter. Not knowing how to assess technical care, patients judge quality mainly by the attributes of the interpersonal relationship with practitioners--personal interest, empathy, responsiveness, and trust--and by whether the outcomes of care meet their expectations. Some requirements for maintaining and enhancing quality include values, human and material resources, knowledge, system design, and performance monitoring. Without a commitment to quality, healthcare practitioners betray not only those who trust them, but also themselves.