Why a traditional health outcomes approach will fail in health care and a possible solution.

This paper challenges the assumption that improved knowledge of health outcomes and their causation will lead to more rational decision-making, resulting in improved care at lower costs. The assumption implies that the health system completely controls all those functions, factors and initiatives that can affect the implementation of the standard. These include policies, procedures, applications of techniques, skill mix of staff, inter-team interaction, communication systems, education, and so on. Changes in policy do not automatically mean a change in practice. Implementation is often approached in a manner that is perceived by staff as punitive, focusing on changing the individual rather than the system in which they work. Not only is this approach opposite to basic total quality management principles, but it also fails to acknowledge that most of the improvements arising from the health outcomes approach are a result of staff being prepared to continuously work harder, often ignoring the 'system', to maintain their high standard. However, continuing deterioration in the system in which they work sets the scene for an accident or incident to occur. The answer lies in revisiting the traditional quality assurance cycle and acknowledging that health care has never been able to effectively 'close the feedback loop', that is, the health system is continuously increasing the sophistication of data collection techniques without giving equal consideration to what needs to be done to ensure effective implementation and evaluation. This paper outlines how Campbelltown Health Service directly addressed this issue through its process of achieving international certification to ISO 9002:1994.