Challenges for the quality movement.

Recent developments in the control of the performance of the health system are making it increasingly important that effective quality systems are in place. However, there is significant evidence that many quality programmes are not effective, and, in particular, resistance by many medical and other clinical staff continues. It is, therefore, important for people concerned with the implementation of quality programmes to look at the reasons why quality efforts are not meeting expectations. Areas that need attention include the willingness to apply failure analysis to programmes, recognition of the characteristics of the professional service environment, and the implications for the organizational and management context of effective quality programmes.