More recently, however, explicit, formal evaluation of medical care has become more commonplace, often, as in the UK, being introduced in response to government directives. When introduced in this more mandatory way, evaluation of medical quality has frequently been interpreted as an inspection based approach that is being imposed by central government. Within the field of medical audit in the UK, therefore, clear distinctions have been drawn between audit as an internal, peer review activity and audit as an external, regulatory mechanism (Shaw, 1980). These two perspectives can be seen to reflect features of the individual and inspection-based approaches to quality evaluation, respectively.
Recently, there have been increasing calls for medicine to move beyond the individual and inspection-based approaches, towards the improvement based model of quality, influenced by a perceived failure to complete the audit cycle and change clinical practice. In order to promote such improvement-based approaches, Berwick and colleagues identify the need for practitioners to take on a set of 'new clinical skills', including skills in team-working, process analysis, guideline development and collaborative working with patients, managers and other professional colleagues (Berwick et al, 1992).
Developments in nursing
Within the nursing profession, them is less of a tradition of a craft-based approach to organising work and, compared to medicine, considerable shifts in the underlying methods of organising work are apparent. What is of particular interest is whether these changes have been accompanied by corresponding changes in methods of
