“Examining the quality of medical care is an idea whose time has come…”1 and within the American College of Nurse-Midwives and midwifery services across the country, energies are being directed toward exploring the field of health care evaluation and quality control. It is important that we, as an organization, have a firm understanding of the “state of the art” of evaluation of health care; deciding what the underlying purpose of evaluating midwifery care would be (control of cost, assurance of quality, peer involvement2) and chosing appropriate methods of evaluation to fullfil the purpose(s).
Obstetrical care is one of the unique areas within health care as it encompasses a circumscribed period of time with an end point. Therefore, both the process (content of care) and the outcome (end results of care) approaches to evaluation might be utilized and joined with the structure approach (setting, staffing, organization and financing which surrounds the provision of care). Various methodological techniques and approaches are being utilized such as the tracer method,3 requiring that all methods be studied and the appropriate method(s) be chosen which will meet the objectives.
It is imperative before any evaluation techniques are utilized that we define an set implicit or explicit criteria which serve as the ‘mirrors’ against which to evaluate the structure, process and outcome of care.
Consideration should also be given to implementing evaluation techniques which are applicable to midwifery practice nationally allowing for inter-service comparison as well as serving as techniques whereby individual midwives may moniter and improve their own practice.