
           CQI - THE WAVE OF THE FUTURE IN HEALTHCARE? 
                                                                
                                                                
                     QUINN BECKER, M.D., 33 
                      Former Surgeon General 
                        United States Army 
                          Chief of Staff 
                     Veterans Administration 
                          Medical Center 
                    Asheville, North Carolina 
                            28805-2087 


THERE IS A CRISIS in American healthcare today brought on by 
double-digit annual increases in the cost of healthcare. 
Insurance premiums are escalating. The amount the patient has to 
cost-share is also rapidly increasing. Our government is working 
frantically to make some inroads on these increases. The 
healthcare industry is also desperate to bring costs under 
control. 

   There is no easy solution. There is, however, light at the end 
of the tunnel. CQI (Continuous Quality Improvement) is coming to 
the healthcare industry. It is the wave of the future for 
American medicine. The body that inspects and accredits hospitals 
in the United States, the Joint Commission on Accreditation of 
Healthcare Organizations (JCAHO), has mandated that hospitals 
wishing to be accredited, must have in place within the next few 
years a viable CQI program. 

   This will force change, but will the result be good or bad? It 
has been the salvation of many industries in this country, but 
can it save the American healthcare system? I say "Yes!" 

   Japan has been a leader in quality improvement. That nation 
started the quality revolution in the industrial world and has 
developed automobiles and electronic products of such high 
quality that they have nearly captured the market in this 
country. An American, Dr. W. Edwards Deming, was  used  as  a 
consultant by the Japanese many years ago. He showed them how a 
quality improvement program could decrease their costs and 
improve their products. American industry was very slow to follow 
suit and has learned the hard way. Americans want quality 
products. This is just as true for healthcare as for television 
sets and automobiles. 

   CQI is customer oriented. It starts with the premise that the 
customer must be satisfied. In healthcare this will be an 
enormous windfall for the patient. Hospitals, instead of relying 
on the old adage that what is good for the hospital is good for 
the community, must examine patient satisfaction in great detail. 
They must then cause changes in the care delivered to ensure that 
the patient is satisfied with all aspects  of  his  or  her 
encounter with the healthcare institution. This means more than 
better parking, tastier food, and fresher linens. It means 
decreasing the complication rate from surgical procedures, 
increasing the effectiveness of medications and treatments, and 
decreasing the mortality rate. 

   How can this work? There will have to be a revolutionary 
change in the management of the healthcare industry. At the 
present time management is directive and tells the employees what 
to do (with the possible exception of the hands-on 
practitioners). 

   The secret of success of CQI is that it empowers the employees 
to improve quality. This cannot be a single-department solution. 
It must take people from across many departments in the hospital 
and put them together, allow them to identify the problem and 
come up with a solution. Management must then stand back and 
allow them to institute their change, in fact assist employees in 
making the change. This system is what has brought back some of 
our automobile giants from the brink of disaster. The Cadillac 
division of General Motors recently won the Baldridge Award for 
quality, and it utilizes a CQI type program called TQM (Total 
Quality Management). Significant increases in the quality of care 
can be expected when the employees in an institution are 
committed to customer satisfaction and are responsible for 
improving care. 

   How does CQI save money? In industry money is saved because of 
an ever-decreasing reject rate and redo rate. Fewer and fewer 
cars have to be repainted or doors refitted, etc. In healthcare, 
complications are reduced, and costly visits to the intensive 
care unit or even possible costly law suits are dramatically 
curtailed. The patient's stay is shorter. With a good hospital 
CQI program, it can also be expected that the patients will be 
happier with their care, thereby improving the hospital's market 
share of the healthcare business. 

   CQI is not an easy management process to institute. Managers 
must be fully committed to it. Middle managers have a totally 
different role than previously and must understand that they are 
to support the quality improvement teams in their efforts rather 
than to orchestrate the job themselves. The most basic change is 
that the entire focus of the organization is on quality instead 
of profit. The new philosophy is "if it ain't broke, then it can 
be improved" instead of "if it ain't broke, don't fix it."  The  
organization must select suppliers who produce quality products, 
not products at the lowest cost. A long-term relationship must be 
developed with these suppliers. They must be invited to assist 
with the changes occurring in the organization. Mass inspection 
goes away. The employees are trusted to produce quality work. 
This does not mean that medical care will not be reviewed. 
Monitoring must occur to see if instituted changes have made any 
improvement. 

   Healthcare in America is in trouble. It is imperative that it 
be fixed. We can't go off-shore for this as we have done in large 
part in the automotive and other industries. Continuous Quality 
Improvement may be the very medicine that restores our healthcare 
system to robust health. 
 _____ 

Quinn H. Becker is a member of Western Star Lodge No. 24 and the 
Scottish Rite Bodies of Monroe, LA. He attended LSU Medical 
School, specialized in orthopedic surgery, entered the U.S. Army, 
rose to Surgeon General, and retired in 1988. 


