Readers know that I have considered the true definition of quality for several years. As a profession, we should specify the parameters of accountability. How should a profession evaluate members to certify that they practice that profession with acceptable quality?
As I consider internal medicine (my specific profession), I am trying to deconstruct the skills that a quality internist should demonstrate. I know the answer does not come from performance measurement. I know the answer does not come from “secure” tests. I even know that the answer does not come from patient evaluations.
I am planning to write a paper containing my thoughts on this issue. Over the rest of this week I will postulate some parameters that I plan to include. I want this process to be interactive with my readers, because you stimulate me to look at problems rationally and practically. If my thoughts are wrong, you will have no compunction in letting me know.
My initial outline includes diagnostic acumen, therapeutic management, and bedside manner. Each of these activities includes several specific activities that I will include in my list.
I encourage comments on this introduction.
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Quality is a property of care received by patients, not a property of physicians. Therefore holding individual physicians accountable for quality is a choice, and not necessarily the right one.
Accountability is tricky. Before you decide on an appropriate unit of accountability, you need to get the purpose of quality measurement clear in your mind. Be sure you do this. I suspect you ultimately want to improve the care that patients receive, but I can’t be sure, since you seem so fixated on physicians.
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