Setting System (RCN, 1990). Such practitioner-based methods are based on concepts of decentralisation and local ownership of quality, through devolving responsibility and accountability to the level of practice.
The observed shift in approaches to nursing quality evaluation is closely mirrored by a move towards more patient-focused methods of organising nursing care, away from task allocation towards team and primary nursing structures (Manthey 1980; Titchen and Binnie, 1993). These new work structures are also underpinned by principles of decentralisation and devolved control, important factors supporting the implementation of practitioner-based methods of quality evaluation.
Comparing experiences in medicine and nursing
From this overview of quality developments in nursing and medicine, it is apparent that the two professions have adopted different approaches to quality evaluation, both in terms of the philosophy and the methods that have been applied to implement quality. Nursing has been more familiar with inspection-based approaches, although latterly the focus has been moving towards improvement. Medicine, on the other hand, has a long tradition of individual-based methods of evaluation, although with the greater influence of mandatory audit, the profession has perceived the introduction of inspection based approaches to quality.
From these different starting points, we are increasingly recognising the need for more collaborative, multiprofessional approaches to quality and audit. This is undoubtedly linked to the increasing complexity of care and a growing awareness that many quality problems arise, not within a single discipline, but at the interface of care between
