Maintaining Hospital Quality

NOT long ago, hospitals were considered places to die. More recently, with the introduction of modern surgery and medication, hospitals became safe places in which many people obtained substantial benefit. Today, hospitals are perceived from conflicting perspectives. On the one hand, they are places where lives are saved. On the other hand, they are places where enormous amounts of money are spent and the cost-effectiveness of these expenditures is being questioned, and where some "care" provided there is of no benefit or even harmful. These latter perceptions have led some governments to reduce the growth in hospital funding. This, in turn, has led to unnecessary deaths, increased complication rates, and long waits for elective surgical procedures that are performed to alleviate pain and improve functional status. Hospital quality could decline further if changes in health policy do not explicitly attempt to maintain it. The purpose of this article is to examine the assertion that improving a nation's health care will require measuring hospital quality and using that information to improve decisionmaking both at the physician and patient level and at the policy level.