Abstract
For some time, quality of health care and services has been the topic of major interests of policy makers, health care administrators, health care providers, and consumers and medias in Thailand, as well as abroad. Quality assurance and improvement has gained importance as one of major mechanisms to ensure health security for the population. Nevertheless, to improve quality of the health services system effectively and efficiently at any of the national, provincial, community or organizational levels, we need information and knowledge to guide improvement directions, as well as to determine improvement processes and techniques. Some may be acquired from others, but the others require research, studying and searching for knowledge within our own country. To date, there is no extensive survey on issues in quality of health care and quality improvement that are worth being set as strategies for research in order to bring about knowledge for sustainable quality improvement of our health care system in the future. This research project comprises two parts. The first part is the review of experiences in researches in quality of health care and setting a preliminary proposal for research question frameworks. The second part is a survey of situations and questions among stakeholders, namely providers and clients, regarding quality of the health services system and quality improvement and a summary of strategies to approach quality of health care research. This report is the presentation of the findings from the first part of the project. The objectives were to review published research articles on quality of health care, study research experience on quality of health care in Thailand, as well as case studies in other countries. In addition, it aimed to explore problems and doubts concerning quality of health services from the perspectives of policy makers, system administrators, academicians, hospital quality consultants, hospital accreditation (HA) surveyors as well as health care providers and clients. A number of research techniques were applied, including literature review, in-depth interviews, focus groups, brainstorm sessions, and study visits at organizations in the United States of America (USA) and the United Kingdom (UK) during February to December 2003. The literature review found that research on quality and quality improvement varied a lot in topics, understanding, principles, rationale, utilization and research designs, depending upon contexts and perspectives. There were many definitions of quality. It could only be defined broadly. The scope of research was wide. Only a general framework could be defined for the benefit of review and reference in the following areas: health care provided by health professionals, service delivery, service organization and health services systems, including linkages to health insurance mechanisms and development of aspects related to consumers and service purchasers.
