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June 1, 1994

Quality Health Care

JAMA. 1994;271(21):1711-1712. doi:10.1001/jama.1994.03510450083046

Continuous improvement is a reality in clinical medicine. Derived from industry, continuous improvement (also known as continuous quality improvement or total quality management) was first applied to nonclinical support services.1 Examples of improvement in direct patient care finally have emerged in the literature.

Continuous improvement requires us to apply the scientific method to the everyday provision of health care. It leads us to ask the following questions: What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that we predict will lead to an improvement?2 We can apply the best clinical methods known (with the help of guidelines) and measure the effect (with ongoing measurement of outcomes). We can create cycles of learning by measuring variables in the process of care, determining which has the most significant effect on outcomes, and experimenting with targeted interventions.3 The