Issues in quality assurance--the European scene.

Originally written as a background document for the technical discussion on quality assurance of health services in connection with the 38th session of the WHO Regional Committee for Europe, the paper discusses issues and current trends in quality assurance primarily from the point of view of a health authority. The paper begins with an analysis of factors such as the discovery of an unexpectedly large variation in the quality of care, the increasing complexity of care, augmenting costs and changes in the medical labour market that have increased the interest of health authorities in quality assurance. The next section describes the concepts of quality and quality assurance, and highlights such current trends as broadening of the scope of quality assurance to include outcomes, patient satisfaction and services provided for by other personnel than physicians, and increasing emphasis on the outcome of care. After a discussion of methods used in quality assurance, the paper turns to measures that can be introduced, on the one hand, at the provider and patient levels and, on the other hand, at the institutional level to improve the quality of care. By posing questions to the health authorities on the concept of quality, methods of quality assurance and division of labour in introducing quality assurance, the last section asks, "What does quality assurance mean in Europe?".