Next generation quality, Part 1: Gateway to clinical process excellence.

The quality movement has gone through three phases in this century. The first, quality assurance, emphasized reacting to problems and identifying "bad apples." The second, quality improvement, shifted the focus from individuals to processes but still retained a reactive problem-solving approach to improving the quality of products and services. The third phase, quality management, has gained strength in other industries over the years. The article presents a quality management, or "next generation quality," model for health care centered on clinical pathways as core clinical processes that are continuously improved and monitored through an improved version of variance management systems called the gateway model.