Mitchell Polly, Cribb Alan, Entwistle Vikki A
Kennedy Inst Ethics J. 2019;29(4):367-388. doi: 10.1353/ken.2019.0030.
'Quality' is a widely invoked concept in healthcare, which broadly captures how good or bad a healthcare service is. While quality has long been thought to be multidimensional, and thus constitutively plural, we suggest that quality is also plural in a further sense, namely that different conceptions of quality are appropriately invoked in different contexts, for different purposes. Conceptual diversity in the definition and specification of quality in healthcare is, we argue, not only inevitable but also valuable. To treat one conception of healthcare quality as universally definitive of good healthcare unjustifiably constrains the ways in which healthcare can be understood to be better or worse. This indicates that there are limits to the extent to which improvement activities should be coordinated or standardized across the healthcare sector. While there are good reasons to advocate greater coordination in healthcare improvement activities, harmonization efforts should not advance conceptual uniformity about quality.
“质量”是医疗保健领域中一个被广泛提及的概念，它大致描述了一项医疗服务的优劣程度。虽然长期以来人们一直认为质量是多维度的，因此本质上是多元的，但我们认为，质量在另一种意义上也是多元的，即不同的质量概念会因不同的背景和目的而被恰当地引用。我们认为，医疗保健领域中质量定义和规范的概念多样性不仅是不可避免的，而且是有价值的。将一种医疗质量概念视为普遍定义良好医疗保健的标准，会不合理地限制人们理解医疗保健好坏的方式。这表明，在整个医疗保健部门协调或标准化改进活动的程度是有限的。虽然有充分的理由倡导在医疗保健改进活动中加强协调，但协调努力不应促成关于质量的概念统一。
