Accountability and quality assurance in health care : the perceptions of nurses, midwives and managers

Abstract

Since its establishment, the National Health Service has presented successive Governments with problems of ensuring accountability of the organisation for the conduct of affairs, and the quality of service. The difficulties are compounded by the dependance of the NHS on professional staff, who each have their own values and collegiate culture. It is argued these include certain perceptions concerning professional accountability. Consequently, reliance on organisational structures and management systems to ensure accountability has met with limited success. This approach has also set the scene for potential conflict between manager and professionals concerning the means of demonstrating accountability. This possibility was explored by examining a range of techniques which have grown in prominence in the 1980s, Quality Assurance. Research centred on three Health Districts, focusing on the largest single group of NHS staff claiming professional status, nurses and midwives. Interviews were conducted with managers, staff responsible for Quality Assurance implementation, and nurses and midwives at clinical level. The ro*le and influence on members attitudes of the main nursing and midwifery professional organisations was examined by interviews with key officers. Empirical data supports the contention that whereas managers view themselves as accountable for the organisation as a whole, nurses and midwives see their accountability as owed primarily to patients, a view reinforced by the professional organisations. Senior Nurse Advisors within Health Districts played a crucial ro*le in the resolution of this dichotomy. Finally, it is argued that Quality Assurance programmes incorporating both perspectives hold the best prospect of improving the quality of health care.

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