Effectiveness, efficiency, excellence: can they coexist in health care?

The conference certainly provided a great deal of food-for-thought for participants. From the imperatives of funding restraint, presented by Dr Scully and Professor Manga, to the public attitudes and opinions research presented by Allan Gregg and the anticipated public policy initiatives presented by Senator Kirby, the audience was challenged to take a new look at health care. Chief Ovide Mercredi presented a very earnest plea on behalf of the aboriginal people of Canada for restoration of their dignity and self-determination, as a key to better mental and physical health. The message to health care leaders was that quality improvement not only works, but also leads to more efficient use of resources. Dr Donald Berwick blew away the myths that often prevent organizations from establishing quality improvement programs and presented a blueprint for success. Other speakers gave examples of successful QI programs they were personally involved in. One of the most interesting presentations was Dr Naylor's able exposition of the role of research in assuring quality. This must have opened many eyes to how resources can be used without real benefit to patients, when proper outcome measurement is not used. Indeed, outcome measures may be an important key to dealing with some of the problems facing health care.