Institutional and professional responsibilities in quality assurance.

The quality of care has three components: the goodness of technical care, judged by its effectiveness, the goodness of the interpersonal relationship, judged partly by its contribution to technical care, and the goodness of the amenities. Quality assurance protects and enhances quality through system design and performance monitoring. Monitoring may occur informally in the course of collaborative practice. Formal monitoring is conducted by: (1) systematically collecting information about the process and outcome of care, (2) identifying patterns of practice, (3) explaining these patterns, (4) acting to correct deficiencies, and (5) verifying the effects of remedial actions. Rather than being a policing activity, monitoring implements professional accountability and contributes to rational management by documenting the quality of the product. Its effectiveness depends in specified ways on (1) leadership, (2) organizational characteristics, (3) characteristics of health care professionals, (4) features of the method of monitoring, and (5) methods used to influence practitioner behavior.