Quality issues in health care research and practice.

The Institute of Medicine's comprehensive program for quality improvement is based on many years of data observation, collection, and analysis. This work was performed by practitioner-researchers and efficiency consultants from many disciplines. The resulting recommendations are striking in their straightforward practicality and in their insistence that process factors determine output. According to Leape and colleagues (1991) "most adverse events are preventable...particularly those due to error or negligence." Leape et al. (1991) note that in industry, "an error rate that exceeds defined norms is deemed unacceptable" and urge that similar norms apply in medicine. As knowledge and technology improve, the results of quality undertakings are certain to foster health care's development into an endeavor in which errors are becoming increasingly rare events.