Eisenberg J M, Kabcenell A
Inquiry. 1988 Spring;25(1):78-89.
Larger, more complex medical care organizations have the inherent capability to improve the quality of the care they deliver because of the improved competency that follows higher volumes of service, the interdependence of staff, and the emergence of responsible leadership in large organizations. The potential for slackened physician-patient relationships, however, could jeopardize that quality. We suggest that professional associations can counterbalance the negative influences of large organizations. We envision that the changing political and economic environment of medical practice, along with the greater professional and public scrutiny of care in highly visible large organizations, will act together to exert pressure on organized practices to examine and demonstrate quality clinical practice.
规模更大、更复杂的医疗保健组织具有提高其提供的护理质量的内在能力，这是因为随着服务量的增加，能力得到提升，员工之间相互依存，且大型组织中出现了负责任的领导。然而，医患关系可能变得松懈，这有可能危及护理质量。我们认为专业协会可以抵消大型组织的负面影响。我们设想，医疗实践不断变化的政治和经济环境，以及公众对大型知名组织的医疗服务进行的更严格专业审视，将共同对医疗机构施加压力，促使其审视并展示高质量的临床实践。
