A report card on continuous quality improvement.

Efforts to incorporate the principles of continuous quality improvement (CQI) into health care have been underway for about ten years. In order to understand the lessons of this decade of experience, senior organizational leaders and experts in the field of health care were interviewed. This select group agreed that there have been concrete accomplishments: the tactic of assigning blame for mistakes to individuals is gradually giving way to an emphasis on detecting problems with process; there is a new focus on the health care customer; and many valuable projects have been inaugurated. Nevertheless, the interviews underlined the reality that the movement has not yet made a sizable impact on the U.S. health care system. Until there is a profound, organization-wide recognition of the need for change, universal commitment to CQI principles will not be achieved.

[1]  Russell S. Kirby,et al.  The Dartmouth Atlas of Health Care , 1998 .

[2]  E. Fisher,et al.  Geographic variation in expenditures for physicians' services in the United States. , 1993, The New England journal of medicine.

[3]  D Blumenthal,et al.  The case for using industrial quality management science in health care organizations. , 1989, JAMA.

[4]  M. Walton.  The Deming management method , 1986 .

[5]  David Blumenthalt,et al.  Improving clinical practice : total quality management and the physician , 1996 .

[6]  S M Shortell,et al.  Promoting clinical involvement in hospital quality improvement efforts: the effects of top management, board, and physician leadership. , 1997, Health services research.

[7]  D. Berwick.  Harvesting knowledge from improvement. , 1996, JAMA.

[8]  E. O'Connor,et al.  Implementation of total quality management: conventional wisdom versus reality. , 1996, Hospital & health services administration.

[9]  Joseph Moses Juran.  Juran on leadership for quality : an executive handbook , 1989 .

[10]  D Griffith,et al.  Facilitating the recovery of open heart surgery patients through quality improvement efforts and CareMAP implementation. , 1996, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[11]  J S Zinn,et al.  Resource dependence and institutional elements in nursing home TQM adoption. , 1998, Health services research.

[12]  S Sauer,et al.  A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. , 1997, Critical care medicine.

[13]  Donald Berwick,et al.  Physicians as Leaders in Improving Health Care: A New Series in Annals of Internal Medicine , 1998, Annals of Internal Medicine.

[14]  Russell L. Stogsdill,et al.  A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group. , 1996, JAMA.

[15]  W. Edwards Deming,et al.  Out of the Crisis , 1982 .

[16]  W. O’Neill,et al.  Regional variation across the United States in the management of acute myocardial infarction. , 1995, The New England journal of medicine.

[17]  L R Burns,et al.  Managed care, market stages, and integrated delivery systems: is there a relationship? , 1997, Health affairs.

[18]  William W. Scherkenbach.  The Deming route to quality and productivity : road maps and roadblocks , 1986 .

[19]  Gustavo Stubrich.  The Fifth Discipline: The Art and Practice of the Learning Organization , 1993 .

[20]  E. O'Connor,et al.  Assessing the impact of continuous quality improvement/total quality management: concept versus implementation. , 1995, Health services research.

[21]  James D. Westphal,et al.  Customization or Conformity? An Institutional and Network Perspective on the Content and Consequences of TQM Adoption , 1997 .

[22]  D M Berwick,et al.  Eleven worthy aims for clinical leadership of health system reform. , 1994, JAMA.

[23]  John E. Wennberg,et al.  Geographic Variation in Expenditures for Physicians' Services in the United States , 1993 .

[24]  E. Fisher,et al.  Hospital readmission rates for cohorts of Medicare beneficiaries in Boston and New Haven. , 1994, The New England journal of medicine.

[25]  D M Berwick,et al.  Continuous improvement as an ideal in health care. , 1989, The New England journal of medicine.

[26]  L Pilote,et al.  Regional variation across the United States in the management of acute myocardial infarction. GUSTO-1 Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. , 1995, The New England journal of medicine.

[27]  Daniel Roos,et al.  The machine that changed the world : the story of lean production , 1991 .