The seventh element of quality: the doctor-patient relationship.

BACKGROUND AND OBJECTIVES National experts have defined the elements of quality health care, but community-based physicians have not been systematically asked their opinions about quality. This study explored primary care clinicians' beliefs about the elements of quality care. METHODS Responses from structured interviews with 12 primary care clinicians and open-ended comments in a subsequent survey of 85 clinicians, all employed by a large urban federally qualified community health center, were coded independently by two researchers and analyzed for major themes. After discovering that these themes resembled the six elements advanced by the Institute of Medicine, the data were recoded to identify additional perceptions about quality. RESULTS Clinicians believe that the relationship with patients is a core element of quality health care. They also reconfirm the elements of quality advanced by the Institute of Medicine--safety, timeliness, effectiveness, efficiency, equity, and patient centeredness, with safety mentioned infrequently. The clinicians also emphasized preventive care. CONCLUSIONS While primary care clinicians' beliefs about quality are generally consistent with experts' definitions, they emphasize relationships and rarely mention safety. Successful efforts to promote quality in primary care should be consistent with clinicians' beliefs about what constitutes high quality.