Total quality management and physicians' clinical decisions

INCREASING concerns about the quality of health care have led to experimentation with and deployment of many new technologies designed to monitor, compare, and improve the clinical performance of health care providers.¹Among the newest and most controversial of these approaches is industrial quality management science (IQMS), also known as continuous quality improvement (CQI), the quality improvement process (QIP), and total quality management (TQM).²⁻⁴ Evidence of the rapid spread of IQMS as an approach to managing quality in health care institutions is plentiful. The Joint Commission on Accreditation of Healthcare Organizations has adopted IQMS as an important standard in its reviews of health care institutions.⁵Based on a recent national survey,Hospitalsmagazine estimates that 3100 US hospitals with more than 50 beds now have programs in TQM.⁶An increasing anecdotal literature describes the success of IQMS in analyzing, ameliorating, or solving particular health care problems.