Quality Assurance in Diagnostic Case Formulation

One idea around which more consensus seems to have been reached is that qualitative research is only solid if it passes the critical test of methodological quality criteria. The past few years have seen the publication of overview studies on factors that need to be taken into consideration when monitoring the quality of qualitative research. The underlying idea is that the soundness of scientific research does not depend that much on the type of data that it collects—quantitative or qualitative—but on the methodology used. Scientifically sound research implies that sources that might distort the decision-making process are excluded as much as possible, or controlled for by using systematic reflection.

In what follows I discuss three major points of attention to monitor the quality of qualitative research: reflexivity, reliability, and validity. Reflexivity is pivotal to good quality assurance, and indicates the need for an overall critical attitude. Reliability relates to the importance of systematic work and to excluding possible sources of distortion.

Validity concerns the efforts to guarantee that findings are correct. With my discussion of these points I will also indicate how they can be applied to diagnostic case formulations. Some readers may be surprised by this great emphasis on quality assurance and by the detailed focus on the methodology of qualitative research. Following the critiques on psychiatric diagnosis, as discussed in Chaps. 2 and 3, I believe that within the practice of clinical diagnosis more attention should be paid to the soundness and accuracy of the processes through which we draw conclusions about people’s mental health condition. Diagnostic statements have far-reaching implications (what interventions are or are not taken? Which characteristics are attributed to a person? etc.), and must therefore be well founded and carefully constructed. Most of the methods for quality assurance that I propose are not new. However, often these methods are not integrated into a systematic quality policy and I would appeal for this to be done. Mental health care professionals and organizations would enhance the inherent quality of their diagnostic work and the trustworthiness of their conclusions if they clarify how they optimize the components of reflexivity, reliability, and validity.

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