Status of Quality Assurance Programs in American Hospitals

Abstract

Quality assurance has rapidly become part of the everyday vocabulary of clinicians, researchers, and administrators in our health care system. It is an idea whose time has come, although it is not a new idea. Dr. Francis Clifton, an 18th century English physician, promoted the basic principles of this process,1 as did Florence Nightingale in the 1860s.2 Dr. Ernest Codman advocated an end result system of hospital organization3 in Massachusetts at the turn of this century, an endeavor that eventually led to the formation of the American College of Surgeons and the establishment of the Joint Commission for Accreditation of Hospitals in 1951. Most recently Donabedian,4'5 Berwick,6 and others have pioneered a scholarly approach to health care quality assur-