Incorporating outpatient perceptions into definitions of quality.

This paper reviews the ways in which quality measures have been defined by reference to objective measures and applied by the producers of health care to patients. Patient satisfaction surveys may be thought to redress this imbalance and will be addressed as a precursor to the discussion of the SERVQUAL methodology, developed to measure the gap between expectations and performance in service industries. An argument will be advanced that quality measurement is still producer-led and should incorporate the views of patients more directly into the quality measurement process. It is suggested that calibration or baseline surveys of patients be conducted which then identify the issues that may be subject to more sustained quantitative analysis. Quality monitoring should be conducted in such a way that particular sub-groups can be subject to routine analysis. Models of quality measurement need to incorporate the perspectives of many 'key players' in which the views of patients are complemented by relevant professional, clinical and managerial groups. The extent to which there is a disjunction between quality as objectively measured (e.g. by waiting times) and as experienced by patients will receive attention. Suggestions will be made that monitoring and clinic operations need to be more mutually reinforcing.