Research and development in quality of care: establishing the research agenda.

Introduction Quality of care has, in the past decades, evolved into a new important field of work including activities such as quality assurance, clinical audit, quality improvement, and quality management. It has gradually become a domain with its own concrete aims, its own typical methods and techniques, and its own specific educational programmes, journals, societies, meetings, conferences, laws, and budgets.' Russel and Wilson speak of clinical audit as "the third clinical science".2 Whether this is true or not, quality improvement and clinical audit pose at least new challenges for every person and institute in health care. New expertise is required: people who can provide education and support on quality improvement, such as audit facilitators and quality managers. New feasible and effective methods for quality improvement are also needed, such as methods for setting guidelines, reviewing or auditing performance, inducing changes in provision of care, and managing quality improvement actions. Consequently a new field of research and development has evolved, aimed at optimising the quality of patient care. In some countries even specific research budgets for research on quality of care and quality improvement have been established (The Netherlands, Norway, United Kingdom). From this, questions arise about the specific role of research on quality of care and quality improvement. Is it different from clinical research or health services research; and what are its specific features and research questions? This paper, for researchers and policy makers, provides a reflection on the role of research and development in quality of care, which is characterised by its own particular subject and research questions.