Sustaining CQI.

Abstract

Angst and malaise. Dr. Z. Stern, writing on CQI in this issue of the Journal, has the prescription for health care improvement in hand, has convinced at least some of his hospital administrators and personnel of the wisdom of his approach and has started to put some antlers on the wall. Yet he is wringing his hands. Can management's commitment to CQI be sustained long enough to reap the anticipated rewards? Will physicians ever be engaged so that the benefits of CQI can be extended to the clinical realm? Fin de stick ennui and the journey has barely begun. As Dr. Stern notes, CQI has come into prominence during a prolonged crisis in health care delivery. Just as struggling industries embraced CQI in an effort to regain their competitive advantage, so hospitals have adopted CQI in the hope that it will help them reduce costs, secure contracts with payers and attract patients. In the United States, CQI has received a powerful but somewhat artificial boost by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which has virtually mandated CQI as the workhorse of organizational improvement. However, not even the JCAHO will be able to prop up CQI for long if it produces only small, local improvements without bolstering the overall business position of hospitals. If CQI fails to deliver on the bottom line, despite full backing by management, it will prove to be — as Dr. Stern fears —just another passing fad. In essence, hospitals are engaged in a vast natural experiment of unprecedented proportions and definitive results may not be available for some time. In the meantime, management's commitment and attention can, in my view, best be preserved by following a simple CQI model that has been codified particularly clearly by Langley and Nolan [1]. This model poses three fundamental questions: