Uncertainty in Clinical Knowledge: A Critical Dimension of Quality Evaluation

This article explores the ways in which uncertainty can be incorporated into the understanding of better performance approaches, and is thus proposed as an enabling dimension of performance. The enabling characteristic of uncertainty is of special interest to designing educational programs for providers in assistance to the amelioration of care through the application of available knowledge, be that from data relating processes to outcomes, or based on feedback providers get from patients and families about their expectations from the care. Tracing the keystone definitions of uncertainty from Hippocrates to Osler, the discussion addresses the dimensions of decision - making appropriateness, its timeliness, the expected and actual value of the care services, and the role of systematic communication between providers of care as well as with patients. The crucial role of Health Information Technology is emphasized, and a unifying model is proposed where the inclusion of uncertainty as a dimension of performance promotes an encompassing evaluation of the quality of health care services. Evaluation, influenced by tradition and precedent, is discussed as requiring the inclusion of health care and caring services.