Quality improvement in health care - Conceptual and historical foundation

During the past decade, quality improvement (QI) has become the primary app roach for health care organizations to measure performance and implement ch ange. From a historical perspective, QI has multiple origins: in systems en gineering, as a way of defining production processes; in quantitative analy sis, as a methodological approach for collecting and analyzing data; and in organizational behavior as a way of understanding how el fits with an orga nization's structure and management philosophy. Although eland evaluation s hare similar goals, as modes of inquiry, they del eloped in very distinct a nd separate settings, to fulfill different needs. However these differences are now beginning to merge as el gains acceptance as a desirable and legit imate approach for health care organizations to enhance service delivery an d outcomes. This article describes the conceptual foundations on which el i s based and identifies historical events that have influenced the developme nt of el and its adaptation by health care organizations. (C) 2000 Sage Pub lications, Inc.