Moving from quality assurance to continuous quality improvement

Though numerous proponents of the change from quality assurance (QA) to continuous quality improvement (CQI) have emphasized the drawbacks of the former and the advantages of the latter, there has been relatively little systematic consideration and comparison of the costs and benefits of each. A proper comparison is probably not possible, because the data seem to be lacking. Instead, much of the discourse has been based upon anecdotes, analogies from other industries, and unsupported assertions. This article grows out of a concern that, in making the switch from QA to CQI, we will discard or inadvertently lose much of value in QA and may not achieve many of the things that proponents expect CQI will accomplish. QA has served the health care field well. Its achievements ought to be preserved and built upon, not discarded.