Quality Assurance and the Logic of Evaluation

The question as to why it is necessary to evaluate an essentially evaluative exercise ‐ namely quality assurance ‐ is first examined. It is claimed that because quality assurance is not merely an assessment of health services but a strategic intervention into patient care and/or health care services there is a requirement to verify and monitor the type of quality assurance system being used. Such a requirement can be legitimised either on ethical grounds or on pragmatic grounds. The former position suggests that it is in fact wrong to employ systems whose efficacy and rigour is unproven and unmonitored while the latter position suggests that the potential fallout from a quality assurance programme that fails is of such magnitude that some form of evaluation ought to be undertaken as a matter of course. There follows an examination of some areas that one may want to consider in such an evaluation. These are based on the tripartite split of the elements of quality assurance found in Donabedian′s early work. Finally the question as to the relative merits of an evaluation contained within the quality assurance programme itself and one external to it is addressed.