Devising a multidisciplinary audit tool

Developing service quality in mental health services

Through a literature review, this paper demonstrates that there is a lack of knowledge about quality management within the mental health services. Ideas about quality from the wider services sector are then discussed, and a case study of a mental health scenario is provided. It is argued that health service generally, and mental health services in particular, have much to gain from becoming more closely aligned with the wider field of knowledge of quality management. Concludes that the wider techniques of managing service quality may prove useful, particularly in mental health services, due to the nature of such services and their inherent variability.

Managing by numbers: using outcome measures in the NHS

The paper explores the literature concerning outcome measures used in health services. The need to measure outcomes subsequent to encounters with health services has been identified and occurs as a result of the current "value for money" approaches being used within the NHS. Provider units are required to establish the effects which interventions have had on the health of each individual using their services, despite the fact that definitions of health outcomes used by both professionals and managers are problematic. It is suggested here, however, that outcome measures which answer all requirements will remain elusive, and their effectiveness will vary according to the circumstances of their generation and use. Moreover, the very use of outcome measures as management tools can lead to a subversion of the meaning which led to their selection in the first place. Managing by (outcome measure) numbers is not a realistic way forward.

Why the NHS should abandon the search for the universal outcome measure

This paper considers the use of outcome measures in the British National Health Service (NHS). Measuring outcomes is a major conceptual and practical problem. Many different measures are currently available yet no consensus has been reached on which should be preferred over others, or about which should take priority when they conflict. Some currently used measures are described, the relationship between these measures and the measured activities are discussed, and fundamental problems with both the measures and their use are revealed. It is shown that however assiduous the search, the 'perfect' outcome measure will always remain elusive.

Involving patients in the provision of community care: a change in philosophy

The National Health Service (NHS) has many different kinds of professionals and managers working underneath its large umbrella: non-clinical managers administer the work of health-care professionals, who in turn are concerned with the management of patients' treatments. Delivery of health-care services involves the managers and professionals working together to achieve a service that is good for, and acceptable to, patients. A change in the philosophy of the NHS is indicated by the growing acceptance, by both managers and professionals, of the necessity to elicit the views of patients (i.e. the expectations and perceptions of service users) and to incorporate these views into the planning and implementation of services. Discusses one such attempt to elicit the perceptions of service users, and reports on the preliminary findings of a patient-centred audit which has been undertaken in Southend Community Care Services NHS Trust. Discusses the effects that the audit has had on the chiropody services in Southend, for both non-clinical managers and health-care professionals, in order to highlight the usefulness of the approach.