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Heroes and martyrs of quality and safety
John Williamson and the terrifying results of the Medical Practice Information Demonstration Project
  1. D Neuhauser
  1. The Charles Elton Blanchard Professor of Health Management, Professor of Epidemiology and Biostatistics, Co-Director, Health Systems Management Center, Case Western Reserve University, Cleveland, OH 44106-4945, USA; dvn@po.cwru.edu

https://doi.org/10.1136/qhc.11.4.387

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    Here is how Avedis Donabedian described John Williamson’s contributions in a letter written in July 2000. “Many years ago, much before the assessment of outcomes became so fashionable a slogan, Williamson perceived that ‘outcomes’ should indeed be the focus of attention in assessing the quality of care . . .” Williamson’s concept of quality is “achievable benefit not achieved”. Donabedian said that Williamson’s 1978 book “Assessing and improving health care outcomes”1 “deserves to be one of the classics in our field”. “Williamson insisted that assessment of quality should involve not only physicians but a team of health workers cognizant of the issues at hand. I should add that Williamson can be considered the founder of a school of quality studies”, influencing the work of Robert Brook, Evert Reerink and Alison Kitson.*

    John is now retired and living in San Diego. He is ready to talk and laugh and seems more bemused than angry over the consequence of his 1976–9 study of the evidence in support of quality of care. How could such a person get into trouble in pursuit of better quality?

    THE NEED FOR EVIDENCE ABOUT BEST PRACTICE

    In 1975 William Munier, MD was the national director of the Professional Standards Review Organizations (PSROs) working for Theodore Cooper, MD who was Assistant Secretary for Health in the US Department of Health Education and Welfare (HEW) from 1975 to 1977.2,3 The PSROs were created at the state level of government to review the use of services and quality of care related to the Federal Medicare program.4,5 PSRO staff did examine length of hospital stays, but were mostly mystified over how to set standards for quality of care evaluation. Williamson and his colleague Peter Goldschmidt, MD (publisher of “Report on medical guidelines and outcomes research medical care management corporation …

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    Footnotes

    • ↵* Other books by Williamson include “Improving medical practice and health care. A bibliographic guide to information management in quality assurance and continuing education”, Cambridge, Mass: Ballinger, 1977, 1035 pp (containing 3500 abstracts) and Williamson JW, Weir CR, Turner CW, et al. “Health care informatics and information synthesis”, Thousand Oaks, CA: Sage, 2002.

    • ↵† This paper briefly summarizes Williamson’s MPIDP project and was in print before the embargo was imposed (Williamson, personal communication, February 2002).

    • ↵‡ There is no written documentation in support of Munier and Williamson’s perception. Such prejudgement would be completely inconsistent with official NIH policy (Williamson, personal communication 30 July 2002). Note, however, that Williamson’s following career moves can be understood by this perception of his.

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