The recent emphasis on outcome assessment has required hospitals not only to practice high quality care but also to prove that they do so. In search of leadership, many hospitals have turned to epidemiologists and infection control practitioners (ICPs), arguing that there are strong parallels between their activities and those of quality assurance. Both have the same ultimate goal of improving the health of the patient. The principles of surveillance, data management and problem solving used in epidemiology apply also to quality assurance. As advisers, participants or leaders, epidemiologists and ICPs are being drawn irresistibly into the field of quality assurance.

The need for leadership has arisen because the assessment of quality is a surprisingly complex task. Initial approaches are often unstructured and designed to fulfill the requirements of various regulatory agencies rather than to improve the delivery of care. In addition, quality assurance is costly, and financial restrictions on medicine are increasing. It is time to take a serious look at the cost-effectiveness of quality assurance and apply the techniques of medical decision analysis to combat the inefficiency and ineffectiveness that often dominate the field.