Towards a multi-view model of quality in primary health care: User involvement in the North West region of England

Abstract

Issues about quality are paramount in the NHS. Part of this, is the Government's declaration of partnership at all levels with user involvement at its centre. Clinical Governance has been introduced as the mechanism to deliver quality, by encouraging professional accountability through one strategic direction. However some argue that this emphasis on clinical quality has
been at the expense of users.
In a management context, Garvin (1988) developed a model that consists of four views of quality. A strength of Garvin's model is that the user view is equally as important as other views. The first part of the study (M-Phil stage 1996-1999) aimed to investigate the context of the user view of quality by studying the user elements within each of Garvin's views. A taxonomy was developed using Garvin's four views of quality in order to classify the many different quality approaches and techniques in the literature. By classifying the literature in this manner, individual frameworks of quality were devised that could be used to assess approaches and techniques in any new quality models. In addition the taxonomy represented a new way of reviewing literature in this area. This coincided with the introduction of Clinical Governance within the National Health Service in 1997. The frameworks were used to assess to what extent this new development represented the four views of quality. The conclusion from this exploration was that the user view of quality remained under-represented despite the introduction of Clinical Governance. The empirical stage (PhD stage 1999-2003) aimed to investigate whether user involvement is
under-represented in PCGs in the North West region of England. The major finding is that the level of user involvement is dynamic. Board members are willing to involve users in discussions and evaluation stages to a large extent compared to lower levels of involvement during priority setting and strategy formulation (key decision-making stages). The results
therefore indicate that PCG Board members' interpretation of user involvement is markedly different to that of the Government.
This research has contributed to the operational i sation of user involvement by providina:
* The first investigation of the degree of development of user involvement agendas within the embryonic PCGs in the North West region of England;
* An exploration of the extent that user involvement agendas coincide with other PCG agendas, particularly Clinical Governance;
* An exploration of the views about user involvement of different professional groups represented on the PCG Boards.
* The development of policy recommendations.