The Paradox of Japan: What About CQI in Health Care?

Abstract

QUALITY CONTROL IN INDUSTRY: Japanese industry, motivated by the need to produce higher-quality products to overcome prewar perceptions of shoddy Japanese products, fueled the growth of a "quality control (QC) circle" movement. However, Japan's health care industry has largely ignored quality as an issue. A PHYSICIAN-ORIENTED HEALTH CARE SYSTEM: Before Western medicine was required, care was provided at clinics, which also served as the physician residences. These clinics later evolved into private hospitals. In this tradition, the closed, feudal, and "sanctuary" nature of the medical system is still present and is reflected in a lack of attention to quality. QUALITY CONSCIOUSNESS IN JAPAN: Physicians have traditionally taken a firm stand against interference in medical matters. The physician-patient relationship entailed the patient's having little knowledge about treatment options--and therefore having submission to and trust in the physician. CRITERIA FOR QUALITY: Few physicians and medical directors in Japan would probably be able to identify quality criteria easily understood by personnel or describe the measures taken to systematically improve the quality of health care. However, in 1987 the Ministry of Health and Welfare and the Japan Medical Association prepared a "hospital function assessment table"--the first attempt ever made in Japan to assess the quality of health care. Efforts to implement QC circles and other quality improvement activities do suggest an increasing interest in quality in the health care industry. There is no reason hospitals cannot benefit from the experience and know-how in quality improvement and management for which Japanese industry is famous.