Table 1.

Approaches to improving the quality of healthcare.

Top-downBottom-up

  • National Directives (eg MRSA)

  • National campaigns (eg dementia)

  • Policy initiatives

  • Inspection and regulation

  • Public reporting of outcomes

  • Using the payment system, eg Best Practice Tarriff

  • Relying on competition between providers

  • Professionally led

    • clinical audit

    • accreditation

    • confidential enquiries

    • peer review

  • ‘Industrial’ approaches to quality improvement (Lean, Six Sigma, Model for Improvement etc)