Technology advances have brought forward new and evolved services and technical infrastructure that promote and enhance quality healthcare services, such as telepresence and wearable technology. Nevertheless, there are several obstacles in telemedicine performance that need to be resolved.
TopQuality Conceptual Approaches
Defining quality is a matter of several parameters and according to Thomas Pyzdek (1990:Chapter 1), even the quality experts do not agree on a consistent definition.
According to Dr Joseph Juran, the concept of quality revolves around the concept of “fitness for use”. Philip Crosby defines quality in terms of performance that produces “zero defects”, whereas Dr. W. Edward Deming defines quality as a “never-ending cycle of continuous improvement” (Crosby, 1994Crosby, 1996 Deming, 2000).
According to a general definition, quality refers to the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
Although the term “quality assurance” was at first the main term for the experts to deal with, concepts “such as “total quality management” and “continuous quality improvement”, have come forth.
Quality assurance refers to a program for the systematic monitoring and evaluation of the various aspects of a project, service, or facility to ensure that standards of quality are being met. It merely concentrates on identifying poor providers rather than defective processes.
On the other hand, Total Quality Management (TQM) refers to a structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceed expectations.
Continuous Quality Improvement (CQI) refers to programs designed for clinical settings and encompasses quality improvement efforts and philosophies.
These two terms are often used interchangeably (McLaughlin et Kaluzny, 2006).
Evaluating quality is of key interest to many groups and individuals related to healthcare services. In an attempt to categorize the healthcare users, we would form two groups:
The first group is the one of the internal users, which includes the board of directors, individual physicians, clinicians, healthcare managers and employees, while the second is that of the external users, meaning the patients and their care givers, private and public purchasers/ payer groups, academic institutions/ researchers and the media.
All of these individuals need to measure or evaluate quality for different reasons. For example, in telemedicine research, the number of controlled variables directly depends on the scientific background of the team carrying out the study, i.e. telecomm variables for engineers, clinical variables for doctors and so on.
TopEnsuring Quality
The quality of services is always determined by certain attributes that they have or should have. The most important attributes health services should have, are accessibility and availability, usage facility, public’s acceptance and all these always in relation to their cost.