ABSTRACT
In modern American health care, there are two approaches to the problem of improsing quality, two theories of quality that describe the climate in which care is delivered. One will serve us well: the other probably will not. Quality engineers occupy a central place in such structures, as quality is brought to center stage in the managerial agenda, on a par swish finance. Flexible project teams must be created, trained, and competently led to tackle complex processes that cross customary departmental boundaries. Physicians who doubt that methods designed to improve quality can help them in daily practice may muskier several questions. Modern theories of quality improvement in industry are persuasive largely because they focus on the average producer, not the outlier, and on learning, riot defense. Health care regulators must become more sensitive to the cost and ineffectiveness of relying on inspection to improve quality.
