4.4 Service-Oriented Quality Models

Meyer defines potential quality of the service provider as one subquality of his Model. Basically structure quality and potential quality refer to the same thing. However, replacing structure quality with potential quality in the Model of Donabedian will be the first methodical improvement. It will keep in mind that the former structure quality is only a potential quality and never for its own sake. Secondly, one becomes aware that the elements of potential quality must be well balanced to be effective and efficient.

Comparing partial potential qualities between different service providers only makes sense in identical circumstances; that is to say with equal service procedures and equal rest potential quality. Needed potential quality must be determined looking backwards from the outcome of process, depending on this situation some missing equipment will be a significant bottleneck or not.

In the authors opinion, much money has been wasted for "improving" structure quality (unbalanced) for its own sake. Of course, the actual situation of medical care in many western countries does not promote the efficient use of equipment resources. For instance, artificial boundaries between ambulant and stationary medical care does not allow adequate resource sharing. Often structure quality seems to be reduced to owning the latest equipment. It seems most readily accepted by physicians: comparing equipment does no personal harm to anyone, problems are materialised and it is very easy to make some kind of equipment norms. Equipment has even been abused as a status symbol. Of course, structure plays an important role in TQM but it can not be reduced to: Who has got the latest equipment and who distresses his patients with he most technical diagnostic procedures? Potential quality keeps in mind that structure is no quality in itself. Equipment is only a part of structure. The quality of human resources (their skills!) and the process organisation towards reaching the best process and outcome must be of the same dimension as the equipment to gain high over all potential quality.

second step: potential quality of the service provider
Meyer divides the potential quality of the service provider into potentials of specification and potentials of contact. Referring to dimension I and dimension II respectively, as defined in 4.1.3.

dimension I: potentials of specification
The kind of combination of staff and equipment should depend on the customer. High specification allows high specific quality. However, depending on the degree of specification, flexibility on the variety of customers is getting lost. Offering Refractive Surgery in a typical universal ambulant one-physicians-practice will probably not offer sufficient specification to deliver up-to-date quality. A private clinic for Refractive Surgery only offering the PRK laser procedure might be too specific, limiting the customer's selection, and will be inflexible towards changing concepts.