Health outcomes: a challenge to the status quo.

Systematic methods such as organizational audit can help to establish standards and review processes in a fledgling service, through reaching a consensus about priorities and introducing ways of assessing progress instead of being overwhelmed by demands and needs or swamped by offers of help of the wrong type.More modest beginnings in quality circles and peer review can enhance the efforts of small groups of drivers of change, helping them to develop teamwork and gain confidence through local successes.None of this will progress far without an initial supply of resources.If relief efforts are disinterested, well planned, and well executed there may be some hope of success, although the record from other parts of the globe is depressing.In my experience to date, the motivation to learn and develop from a very low baseline is perhaps the most striking attribute of nurses in the ex- Communist countries.Also their requirements may not be that different from those of nurses in the United Kingdom.Wherever they are introduced, quality assurance methods which are designed to be an integral mechanism of service development have to be simple, accessible, cheap, effective, and attractive.Perhaps the worlds of nurses are not as far apart as they seem -it is more a matter of degree.We have just as much to learn as we have to teach.