Planning for quality in the NHS breast screening programme.

Managing innovation The development of health services world wide has been piecemeal and uncoordinated. Some control has been exerted over health service resources by controlling capital and by manpower strategies, but these are relatively crude methods largely concerned with control of resources and not with quality of health care provided. The main determinant of the quality of health care is the behaviour of individual professionals, and the innovation of professional practice has been neither systematic nor planned. Consequently professional practice consists only in part of tried and tested interventions; most health professionals also continue to use interventions whose effectiveness is limited and are slow to adopt new interventions of proved effectiveness.'2 The main reason for this has been managerial hesitation to interfere with "professional freedom," but even the health professions now realise that more systematic approaches to innovation must be taken, either through managerial research and development strategies or through professionally led innovation. The importance for quality assurance is that for the first time the first stage in the three phases of quality assurance identified by Juran3 namely, quality planning can be undertaken. Most quality improvement and audit initiatives are attempting to create a more systematic approach to clinical practice in a world in which the main impression is of brownian motion rather than systematic and scientific progress towards better quality. Planning for quality before an intervention is introduced is particularly important in screening because the ethical contract between a health service providing screening and a healthy population is different from that between an individual clinician offering help to someone actively seeking it because they perceive they have a problem. This article describes the use of quality planning in setting up a new health service.