June 8, 1994

Urban Violence in Los Angeles

Author Affiliations

HCA Reston Hospital Center Reston, Va

JAMA. 1994;271(22):1742. doi:10.1001/jama.1994.03510460034019

To the Editor.  —Recent theoretical developments merging industrial management techniques with ideas for improving patient care and the associated systems or processes have gained significant momentum.1 Of the several available methods facilitating process or system improvement, closer alignment of the inputs with the capabilities of the particular process or system and modification of the output structure to represent the need for which the process or system is designed are the most powerful methods for creating the highest leverage for change. After reading the article by Dr Shoemaker and colleagues,2 it cannot be more intuitively obvious that the needed reform of the American health care system can only occur if we, as a nation, openly discuss and fairly redress the issues that create the inputs that overburden the existing processes, drive the cost, and overtax our financing abilities. Simultaneously, the output of the process must be redesigned, creating a

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