1742 Book Reviews

whoee Standuds? clnmlume randRof~Stendardsin Health Care, by CHARU)TTE WILLIAMSON. Open University Press, Buckingham and Philadelphia 1992. 133 pp., f32.50 (hardback) f 10.99 (paperback).

Whose Standards? is one of six books in the State of Health Series, edited by Chris Ham at the Health Services Manage- ment Center at the University of Birmingham, that seeks to advance debate on major health policy issues. Standards is a particularly compelling issue because a more informed public, who expect to be treated like consumers rather than patients, are demanding higher standards of care. The series is directed to students and informed laymen and laywomen, in addition to health policy specialists.

Williamson’s book provides a framework for understand- ing the relationship between consumerists and professionals and explains what consumerists consider a higher standard of care. Chapter 1 introduces the sociological concepts that frame the conflict between consume&t interests and pro- fessional interests, and the potential for the conflict to be resolved. Chapters 2 and 3 describe consumerists and the relationship between these groups and ‘ordinary’ con- sumers. Chapter 4 explains that autonomy is at the heart of consumerists’ standards. The next six chapters look at the following six facets of autonomy in detail: (1) respecting the patient; (2) honoring the support that a patient receives from friends and family; (3) informing the patient about his/her diagnosis, disease and treatment; (4) insuring the patient has appropriate control of treatment and pro- fessional staff; (5) choosing practitioners, facilities and treatments; and (6) making decisions. The two concluding chapters summarize the trends in standards and offer an optimistic view of how consumerists’ and professionals’ interests can converge.

The description of consumerists’ efforts to change prevail- ing practices and of successful pressure groups in England in the first three chapters is excellent. Williamson explains that the challenges consume&s face in changing prevailing practices are similar in many ways to those faced by innovative professionals, who can in fact be allied with the consumerists. The examples of successful pressure groups include the National Association for the Welfare of Children in Hospital, which initially sought to change non-clinical practices regarding children’s access to their parents while in hospital, and the Association for the Improvement in the Maternity Services, which sought choice in maternity care, including clinical practices such as the use of technologies.

The descriptions provide a framework, but not a theoreti- cal model with which to make predictions about the poten- tial for other pressure groups to succeed in changing prevailing practices. For example, how could one predict which of the growing number of pressure groups for a variety of illnesses ranging from AIDS to Lyme’s disease

will be able to change the practices of professionals and when? Readers who are interested in pursuing answers should be directed to begin by looking at theoretical models of the diffusion of new technologies [l] or of collective action [2].

The description of the facets of autonomy in the next chapters are complementary to the literature on patient satisfaction, even though Williamson might not have antici- pated that it would be. It is a rich source of information about the concerns of patients, including direct quotes and anecdotes from patients and practitioners, and examples of practices that respond to their concerns. Listening to patients, and creating a framework for understanding their concerns are important precursors to the more quantitative methods of measuring patient satisfaction, because they provide insights about what to measure.

A shortcoming of the book however, is that Williamson dismisses the literature on patient satisfaction @p. 45-46) and even outcomes (pp. 57-58, and p. 128) too quickly. Research in these fields has developed many of the tools that will be necessary to analyze issues related to standards in the future. In particular, the survey instruments for measuring medical outcomes are in their second or third generation, and they are indispensable for analyzing both the thera- peutic benefit of the practices that consumerists advocate, and for informing patients about potential treatment. Read- ers who are interested in pursuing these issues should begin by consulting a review of the literature on patient satisfac- tion [3] and a description of a leading survey instrument for measuring medical outcomes [4].

On its own terms, Whose Standards? is a valuable intro- duction to the issue of standards, the role of consumerists in challenging standards, and their vision of improved standards of care. The suggestions noted above concern the next steps for readers who want to pursue the issue. Reading Whose Standards? is however, a wise first step.

Department of Health Services, SC-37 MARCIA WEAVER University of Washington, Seattle, WA 98195, U.S.A.

REFERENCES

1. Rogers E. Diffusion of Innovations. The Free Press, New York, 1983.

2. Olson M. The Logic of Colleciive Action: Public Gooak and fhe Theory of Groups. Harvard University Press, Cambridge, MA, 1977.

3. Ware J., Davies-Avery A. and Stewart A. The measure- ment and meaning of patient satisfaction. Hlrh Med. Care Sew. Rev. 1, 1, 1978.

4. Ware J. and Sherbourne C. The MOS 36-Item Short- form health Survey (SF-36). Med. Care 30, 473, 1992.