automatically or easily and that there is a need for careful attention to the processes of implementation to ensure that the underlying principles of the improvement-based approach are upheld. This requires action at strategic, organisational and clinical levels of the organisation to ensure, amongst other things:
・ strong leadership and a clear strategic vision for quality improvement
・ that systems and structures are in place to provide the necessary training for all staff who will be involved in quality improvement activities
・ effective organisational systems of communication to co-ordinate the quality improvement programme and to translate the strategic vision into action.
・ staff at a clinical level have the necessary time and resources to become involved in quality improvement initiatives
Attention to strategic, organisational and clinical issues such as these is essential to ensure an organisational-wide effort towards improving the quality of patient care - one which can perhaps best be described as 'top-led' and 'bottom-fed'.
Future directions for quality improvement
In concluding this paper, I want to look at the current factors influencing the assessment of quality of health care and how these may shape the future direction of developments.
As well as witnessing changes in the methods and approaches to quality assessment, we are also having to respond to new influences and new challenges in relation to
