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DEFINITIONS OF KEY TERMS 47 often based on experiences gained in 'typical' situations." In addition, Vuori states that "standards. . .indicate which level [of a criterion] should be reached. . . ." The Committee's Definition: Standards of Quality Standards of quality are authoritative statements of (1) minimum levels of acceptable performance or results, (2) excellent levels of performance or results, or (3) the range of acceptable performance or results. Given the contradictory uses of the term, the committee decided it was pointless to try to overrule them. Instead, it takes the position that clarity about the nature of a standard is the key issue: does the standard clearly state that it sets a minimum level of performance or a level of excellence or a range? Preferably, specific labels such as "minimal standards" or "standards of excellence" should be employed. Defining standards of quality will be a major enterprise. Another IOM report, Medicare: A Strategy for Quality Assurance (1990), provides an extensive overview of quality assurance activities, methods, and problems and recommends a 10-year strategy for improving the country's quality assessment and assurance efforts and results. In that report, quality of care is defined as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge" (p. 4). One point made about this definition is that it "encompasses a wide range of elements of care." This suggests that standards of quality should be viewed primarily as means for assessing patterns of care, including patterns that may extend across a range of clinical conditions, settings, and practitioners. Advice about whether the Forum should emphasize minimum standards or standards of excellence or ranges is beyond the scope of this report. Among other things, such advice would entail an analysis of alternative views about how to assure quality of care. For example, the concept of minimum standards seems more consistent with the structure-process-outcome model of quality assurance than the continuous quality improvement model. The 1990 IOM report cited above discusses these models at some length, but that discussion provides no simple path for this committee to follow in specifically advising the Forum. Such advice including Vuori and Palmer, see norms as ideal or preferred states. Others treat norm and "average" as essentially equivalent, and they equate the normative and the empirical because empirical data are needed to determine "norms." A 1974 IOM report, for instance, defined ''norm" as "merely a statistical average" (p. 28).
