Implementation of quality improvement methodology and the medical profession

Modern quality management (QM) has evolved in industry over the last few decades to be a major factor in organizational structure and focus. The health industry has to a degree recognized or perceived merits in this model and has applied the principles of QM to many of its activities. It has also incorporated the concept of a commitment to quality improvement (QI) into its most recognized peer-review structure, hospital accreditation (ACHS). Apparent resistance exists in the medical fraternity to a transition from audit-focused quality assurance to contemporary systematic QI. An understanding of this issue may be gained from analysis of the medical profession's perception of QI, factors in the historical structures within health, and a review of the factors which hinder the transition to QI. By considering within a framework of organisational behaviour theory (OBT), some key concepts it is possible to work towards some solutions and proposals. These concepts include attitude, motivation, conflict, organizational change and development. It is likely that the appropriate focus should be broader than the 'recalcitrant group of conservative practitioners who resist change'. Indeed where a deficiency exists, QI methodology would have us look beyond an individual or single group towards the processes that create the opportunity for deficiency to occur. Within the current context, such processes are inherently structural and are historically established within the health industry. A solution to this problem requires organizational commitment and a period of analysis as well as the transformation of attitudes and practices. Organizational commitment will take the form of adequate resourcing and a developmental approach to organizational change. Internal professional change (perhaps guided by organizational development) must address the interface between the 'medical profession' and the broader group of professional health-care providers.