The Influence of External Forces on the Quality Assurance Process

Abstract

In the past, mental health professionals have claimed total ownership of quality assurance and have asked only whether treatment met the usual standards of care. They have resisted intrusions by government regulatory agencies, third-party payers, the courts, and even professional and hospital associations. Professionals have perceived cost containment, safety, accessibility of services, patient satisfaction, and efficacy as irrelevant. Examination of these external elements of quality assurance has, at best, been deemed a necessary evil—more evil than necessary. In more recent years, these external forces have assumed preeminence because of the escalation of costs, consumer advocacy, civil rights litigation, proactive peer review by professional associations, and the acceptance of quality assurance standards set by the Joint Commission on Accreditation of Hospitals (JCAH). In this chapter, the dynamics, impact, and significance of these external forces are examined and discussed.