Quality in nursing care: Context,complexity and the role of professions

Abstract

Requests for quality and affordability have driven healthcare reforms in the UK and elsewhere at all levels of the system. The introduction of some aspects of private markets in healthcare has paved the way to transfers of organisational know-how across the private and public sector. However, the concept of quality has a wider meaning in the public sector, incorporating social as well as individual goals. Furthermore, the incentives needed to achieve improvements in quality are different between the sectors.

The notion of quality incorporates contrasting, even paradoxical ideas: it can be seen as a notion of achieving standards and norms on the one hand, and on the other, as enhancing variability and adaptability to changing environments. While the public sector appears to be moving towards the former, the private sector is moving in the opposite direction. Improving the quality of nursing care means finding quality improvement technologies which can incorporate aspects of healthcare that are among the most difficult to define and measure. This may be a reason why nurses have been less successful than doctors at controlling the quality agenda for their profession. Initiatives in the private sector which focus on adaptability and flexibility may be worth exploring in order to identify innovative ways of capturing important aspects of nursing care which cannot be standardised.