Furthermore, physicians believe that such programs rarely deal with issues they regard as important for patient care. Traditional quality-assurance efforts most often focus on issues identified by regulatory agencies or accreditation organizations. Their agenda has typically consisted of checking documentation, studying credentialing processes, reviewing the work of oversight committees in hospitals, and the like. Rarely do they try directly to improve health outcomes for patients. The second reason for skepticism is the paucity of evidence that, as a whole, previous quality-assurance programs actually did anything to improve outcomes for patients.
Data documenting the effectiveness of newer approaches are likewise scant.
Physicians' training leads them to expect that convincing evidence of effectiveness should accompany any requirement to alter the way they care for patients. Many who try to bring a more cooperative spirit to improving quality find that there is a third reason for being skeptical. Much of what passes for quality improvement can justifiably be viewed as thinly veiled cost containment or marketing. Any attempt to document excellence in outcomes and efforts at improvement is little more than window dressing. So physicians have legitimate questions.