Professionalism, accountability and peer review.

Passage in April 1979 of the new hospital standard on quality assurance by the Joint Commission on Accreditation of Hospitals (JCAH) has given impetus to the development of an expanded literature on the organizational/behavioral aspects of quality assurance. In response to this need for new literature, several conferences on quality assurance were held resulting in the preparation for publication of the four papers included in this special issue of . This paper presents the general orientation which guided selection of the papers. It suggests that if the health sector is to reconcile professional expectations for autonomy with evolving institutional accountabilities for aggregate quality and cost, there must be 1) an expansion of the domain of professional concern from quality to both cost and quality and 2) the development of explicit mechanisms of control both within and external to health institutions.