PubMed · 873370
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B Phillips. 1977. What could we do differently?. https://doi.org/10.1093/hsw%2F2.1.3
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The assessment of quality depends on the eye of the beholder, the patient, the clinician and his colleagues or society/third party payers. There are already several structures that regulate quality: training requirements, judicial control commissions and public health authorities, and in psychiatry also individual supervision and extensive clinical meetings. Most clinical parameters in psychiatry are measurable, but there remains the elusiveness of mental processes, which often defies quantification. Levels of symptoms and functioning, however, can be scored. Computerisation of macro-data often permits useful comparisons, as may consensus conferences and consultations with peers. The essence of quality monitoring is to find indicators that predict results and also reflect the most important situations and problems.
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Dissatisfaction of treatment capacity and of the results of treatment have been two main complaints about the contemporary psychiatric health service. The author tries to sort out what psychiatry itself can do, and what the public authorities can do to reduce the reasons for these complaints. She also shows why psychiatry always has to live with a certain amount of irrational criticism as a part of the essence of its work. In order to reduce the rational criticism, psychiatry can define its obligations more clearly and give priority to certain patient groups, develop subspecialization and more differential treatment, and provide better information to the public. The public authorities can increase the number of professionals in specific programs, and improve the quality of the educational system and research.