Emphasis is changing from quality assurance to continuous quality improvement

EDITOR,--Performance indicators have long been used in the United States as a tool of quality assurance programmes and are now being promoted in Britain.1 The emphasis of quality assurance on identifying “problems” and the “bad apples” in medicine is, however, now being viewed in the United States as counter productive. Unsurprisingly, it is difficult for a negatively oriented process to engender the enthusiasm and capture the support of health …