Abstract
After more than a decade, Continuous Quality Improvement (CQI) in the US is un dergoing a metamorphosis. CQI is being subsumed in a movement that focuses on clinical performance improvement under a number of titles: evidence-based medi cine, case management, disease management, and patient-centred care. Perhaps this is the sincerest form of flattery for an effort built on the industrial concepts of Total Quality Management, but there is more than that at stake. It is a new social contract for practitioners, and a response to both success and oversimplification. While this is taking place in a resource-rich environment, there are lessons to be learnt for both resource-rich and resource-constrained environments. Based on the experience to date, specific action steps are presented to facilitate the implementation process.
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