THE CQI TQM JOURNEY IN FRANCE

Background: In France interest in continuous quality improvement (CQI) and other quality improvement (QI) approaches is recent and experienc e modest, but the pace of change should quicken now that the governmen t has required that all hospitals be accredited within the next five y ears. In addition, in the face of increasing competition, hospitals, p ublic and private, may find a quality strategy to be critical in helpi ng them survive. A national incentive for improvement: In fall 1994 th e National Agency for the Promotion of Medical Evaluation (ANDEM) was mandated by the Ministry of Health to set up a national demonstration project based on quality assurance and CQI methodologies. The program was designed to identify the key success factors for implementing such programs within hospitals. The program involves 28 18-month CQI proje cts, which deal with prevention of nosocomial infection, patient safet y in anesthesia, medical records, blood transfusion safety, drug dispe nsing safety, and control of violence in psychiatric settings. Partici pating hospitals are required to analyze the variation in the involved processes and attempt to reduce variation through cross-departmental quality management programs. The general method for each team's manage ment of the project closely follows the PDCA (Plan-Do-Check-Act) cycle . Preliminary experience suggests that the participating hospitals hav e benefited from following the same model and sharing of accounts of t heir progress. Representatives of the 28 teams met in fall 1995 and Ju ne 1996, and future meetings are planned. Most of the teams have colle cted quantitative data about the current processes and have started to pilot test process changes.