The chapter describes the professional and regulatory landmarks which have influenced the development of the quality movement in health care in the UK and the USA. They reflect the similarities and differences in the approach to quality which have evolved within the National Health Service in Britain when compared with a free market system of health care such as that in North America.
A conceptual framework is used to approach the definition and assessment of quality of health care, noting in particular Donabedian's seminal triad of structure, process and outcome as well as the outcomes movement and other theoretical approaches to defining quality.
The characteristics of criteria, standards, guidelines and protocols are described and the terminological problems in this field are discussed. The use of standards for improving quality includes their application in clinical audit, for accreditation and re-accreditation, in contracting for health services and in regulation and inspection.
There is a new and unfolding relationship between clinical standard setting and management. Concepts such as continuous quality improvement and total quality management are challenging traditional assumptions about the need for a separation between professional, consumer and managerial approaches to improving quality. The National Health Service, following implementation of an internal market for public health care provision in Britain, is well placed to absorb and synthesise the many differing philosophies in the health care quality movement to the benefit of both patients and the health professions alike.