International Journal for Quality in Health Care 2000; Volume 12, Number 3: p.

167

Editorial

The role of external assessment in

improving health care
This issue of the International Journal for Quality in Health Care
focuses on the use of external systems for improving the
organization and delivery of health services.
Ideally these systems are characterized by explicit, valid
standards, by reliable assessment processes and by complementary mechanisms for implementing improvement. For
the purpose of this debate, we have generally excluded systems
which are aimed primarily at clinical practice or training, or
which are statutory inspectorates for the purpose of licensing
health care facilities (including radiation, fire, hygiene and the
general safety of the public and staff ).
Most of the papers in this issue emerged directly from a
3-year research project, funded by the European Commission,
into external peer review techniques (ExPeRT). This identified
two industrial models which have been applied to health care
[the Excellence model, comparable to Baldrige Awards in the
USA, and the International Organization for Standardization
(ISO)] and two models developed within health care (accreditation and peer review visitation). Each of these was
examined in relation to the politics and organization of
national health services and in terms of their methodology,
particularly the validity of standards and reliability of the
assessment process.
Some papers were invited to respond to the general
conclusions of the project from commentators in other
countries around the world. Other papers were invited to
review specific questions (such as the use of numerical
performance measures in external assessment) which had not
been dealt with in detail by the research project.
Inevitably, these papers are either describing or responding
to the situation in Europe, but they also contribute to a
global debate. Within the past 2 years, national reports from
Australia [1,2] Scotland [3] and the USA [4] have examined
and questioned the contribution of external mechanisms not
only to internal development, but also to public accountability.

The common conclusions are that voluntary and statutory

agencies should be actively co-ordinated for consistency and
reciprocity, that consumers should be prominently involved,
that national programmes should be comparable internationally, and that the standards, processes and results
of external assessments should be transparent and freely
accessible to the public.
Can systems, in any country, which were designed to
support voluntary self-improvement, migrate to meet increasing governmental demands for transparency, consistency
and public accountability? In posing this question, I would
like to thank the European Commission and all of those
colleagues in Europe and around the world who contributed
to the ExPeRT project and to this issue of the Journal.
C. D. Shaw
Programme Director, CASPE Research
Leader, European research project ExPeRT

References
1. Australian Business Excellence Framework Healthcare Advisory
Group. A Comparison of Quality Programs. Sydney: Australian
Quality Council, 1999. ISBN 1 875544 76 3.
2. National Expert Advisory Group on Safety and Quality in
Australian Health Care. Report. 1998. www.health.gov.au/
about/cmo/report.doc
3. Scottish Office. Acute Services Review (Carter Report). Edinburgh:
Scottish Office Publications, 1998. www.scotland.gov.uk/library/documents5/acute
4. Presidents Advisory Commission on Consumer Protection and
Quality in the Health Care Industry. Quality First: Better Health
Care for all Americans, 1998. www.hcqualitycommission.gov/
final/

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