To the Editor.
—The articles on quality of breast cancer care by Hand et al1 and Lazovich et al,2 along with the Editorial by Chassin,3 were of special interest to me from my perspective as president of a small Chicago community hospital and as a clinical oncologist. This is the era of continuous quality improvement in our hospitals. We avoid placing blame, ie, finding bad apples (as the lay press has done in reporting JAMA articles), but we identify those problems that lead to the variations in indicators identified by the authors.A striking feature of Chicago's medical landscape is the lack of radiation therapy facilities on the south side of the city. Most small urban hospitals have no radiation therapy. Our machine, a small, rebuilt cobalt unit originally destined for a third-world country, was not installed until 1987. There is no other machine within the city
Friedell PE. Quality of Care. JAMA. 1992;267(16):2186-2187. doi:10.1001/jama.1992.03480160044025