Intended for healthcare professionals


Applying quality improvement approaches to health care

BMJ 2009; 339 doi: (Published 02 September 2009) Cite this as: BMJ 2009;339:b3411
  1. Martin Marshall, clinical director
  1. 1Health Foundation, London WC2E 9RL
  1. martin.marshall{at}

    The health sector could learn much from industry

    People who work in the health system can be resistant to learning from other sectors. They claim that health care is different, and it is hard to argue otherwise when you look at the range and diversity of the stakeholders and the ways in which authority is distributed between them. But some challenges are common to all sectors, and it would be wasteful to ignore transferable solutions.

    The manufacturing sector’s approach to improving quality is a case in point. More than half a century has passed since pioneers transformed Japanese industry by applying simple statistical and behavioural principles, by applying simple statistical methods like statistical process control and behavioural practices such as effective teamwork.1 Companies like Toyota and Unipart have adapted these approaches to produce levels of quality and reliability that the health sector can only dream of.2

    It is not that the health sector hasn’t tried to apply these techniques. Twenty years ago Berwick described how healthcare providers might learn from industry.3 These ideas were first taken up by a small band of enthusiasts,4 5 and they are …

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