Education And Debate

Management for Doctors: The importance of quality: sharing responsibility for improving patient care

BMJ 1995; 310 doi: (Published 15 April 1995) Cite this as: BMJ 1995;310:996
  1. Fiona Moss, consultant chest physiciana,
  2. Pam Garside, visiting fellowb
  1. a Central Middlesex Hospital NHS Trust, London NW10 7NS
  2. b Imperial College of Science, Technology, and Medicine, London SW7

    In health care quality is usually understood in the context of “clinical quality” and an implicit distinction is drawn between managerial and clinical activity. The separate introduction and development of quality initiatives within the NHS has contrived to accentuate the different notions of quality that follow traditional “tribal” divisions within hospitals. Nurses often led quality assurance programmes, while doctors took up medical audit, and managers found that risk management programmes had something to offer their professional concerns. The recent directives to develop clinical audit go some way to addressing these divisions. But the onus of meeting the patient's charter initiatives has provided yet another separate focus for quality improvement within hospitals.

    In other organisations quality improvement is often linked to the concept that quality should be a characteristic of the whole organisation. The process of quality improvement and quality control in the industrial and business world is dominated by the theory and application of total quality management (TQM). This approach to management developed after the second world war when Japanese industrialists, keen to compete with other economies, engaged American experts to advise on the application of statistical techniques to the production process. These advisers, who included W Edwards Deming and Joseph Juran, understood that documenting the technical quality or the specifications of components on a production line would not in itself produce lasting improvement in the quality of production. Instead, by introducing principles and techniques drawn from a wide range of disciplines, they advocated the development of an internal approach to quality improvement, where everyone in the organisation is part of a continual drive to do better. Together, these principles and techniques are described as TQM. The successful results of the application of this approach to manufacturing by the Japanese are well known.

    Much has since been written on TQM …

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