Abstract
<h3>To the Editor.</h3> —The goal of the six-sigma quality program espoused by Motorola Inc, one of the first recipients of the Malcolm Baldridge National Quality Award, is to achieve defect rates of 3.4 parts per million.<sup>1</sup>Rubin et al<sup>2</sup>report that 64% of patients rated their solo practitioner's visit as "excellent." Multispecialty groups and HMOs were rated lower. If one assumes that the specification for an excellent rating is 100%, then clearly even the best-rated practices reported in this study achieve a level of one sigma or less, or a defect rate of 317 400 defects per million. (This is equivalent to 159 misspelled words per page of a book.) When viewed from this perspective, all of the consumer satisfaction ratings reported by Rubin et al were clearly inadequate. The service provided patients even in the best settings in the United States does not come close to achieving
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