CQI in health care: some comments on "can it really work"?

Abstract

In his article on CQI in health care, Dr. Stern makes a number of observations about difficulties in implementing and sustaining Continuous Quality Improvement (CQI) in health care settings. Based on those observations, he raises a number of important questions about the ultimate prospects for CQI beyond some possible success in time-limited, small-scale programs. I will argue in this commentary that, although Dr. Stern may ultimately be proven right about the difficulty of sustaining CQI, his concerns are based on some misapprehensions about both the CQI and the current state of CQI in health care. He has been led to a more gloomy outlook than I believe is appropriate. Only time will tell, of course, but I believe that there is reason to be optimistic about both the impact and the staying power of CQI in health care. In making this argument, I will highlight two significant aspects of CQI that relate to both current status and future prospects. One is its status as an organizational philosophy or organizational culture rather than a discrete program. The other is its applicability to clinical process as opposed to only the administrative or processes of support departments.