ABSTRACT
Managed care is changing how we provide health care and how we manage health care organizations. While the advent of total quality management (TQM) in health care organizations was initially viewed as a panacea for many of the problems associated with quality, the realities of the managed care world have challenged many of these initial expectations. Consider a few of these realities (1):
“Quality” is not the only criterion by which to judge organizational performance, and cost reduction is the watchword of managerial action.
Organizations are characterized by “right sizing,” downsizing, and layoffs unprece-dented in health services with declining employee loyalty.
Improvement initiatives tend to be short-lived and avoid dealing with the substantive challenges facing the organization.
