Blumenthal D, Kilo C M
Health Policy Research and Development Unit, Massachusetts General Hospital, Boston 02114, USA.
Milbank Q. 1998;76(4):625-48, 511. doi: 10.1111/1468-0009.00108.
Efforts to incorporate the principles of continuous quality improvement (CQI) into health care have been underway for about ten years. In order to understand the lessons of this decade of experience, senior organizational leaders and experts in the field of health care were interviewed. This select group agreed that there have been concrete accomplishments: the tactic of assigning blame for mistakes to individuals is gradually giving way to an emphasis on detecting problems with process; there is a new focus on the health care customer; and many valuable projects have been inaugurated. Nevertheless, the interviews underlined the reality that the movement has not yet made a sizable impact on the U.S. health care system. Until there is a profound, organization-wide recognition of the need for change, universal commitment to CQI principles will not be achieved.
将持续质量改进（CQI）原则纳入医疗保健领域的努力已经进行了大约十年。为了了解这十年经验的教训，我们采访了医疗保健领域的高级组织领导者和专家。这个精选的群体一致认为已经取得了具体成就：将错误归咎于个人的策略正逐渐让位于对流程问题检测的重视；对医疗保健客户有了新的关注；并且启动了许多有价值的项目。然而，访谈强调了这样一个现实，即该运动尚未对美国医疗保健系统产生重大影响。除非在整个组织范围内深刻认识到变革的必要性，否则无法实现对CQI原则的普遍承诺。
