Quality Management in Healthcare

Concerns over the quality of healthcare provision are probably as old as the origins of medicine itself. As regards the formalisation of healthcare quality issues, it is assumed that standards governing who was allowed to practice medicine in Egypt and parts of India and China date back to the first century AD (Zineldin, 2006, p. 65). In Europe the licensing of medical practitioners can be traced to Italy in 1140 (Zineldin, 2006, p. 65). During the Medieval period across Europe guilds imposed measures in order to assure some aspects of the quality of care. For example, in the late 1400s, in Edinburgh, the tasks of ‘bloodletting, lancing, shaving, bandaging and treating wounds in battle’ (The Royal College of Surgeons of Edinburgh, 2014) were recognised as the role of surgeons and barbers. A century later, these professionals were given exclusive rights to perform surgery and allowed to prosecute those who infringed on their privilege, while formal regulations for apprenticeship were created (The Royal College of Surgeons of Edinburgh, 2014). These quality assurance initiatives were still embryonic in that they did not significantly affect day-to-day activities of the professionals they regulated. For the most part, quality assurance activities were under the control of individual practitioners, who aspired to perform to the highest standards as part of their commitment to the Hippocratic Oath (Ballard, Spreadbury, and Hopkins, 2004, p. 278).