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Continuous improvement as an ideal in health care. Classic icon

Berwick DM. N Engl J Med. 1989;320:53-56.

Two approaches to improving quality in health care are illustrated in this article. The first, called quality by inspection, is a system based on the belief that quality is best achieved by removing “bad apples.” The second, based on the theory of continuous improvement, calls for understanding and revision of the production process rather than placing blame on the individual. Berwick calls on the health care leaders to begin applying the continuous improvement model in medicine. He outlines a number of critical steps for implementation, including committing resources, organizing within institutions, using modern technical tools, encouraging dialogue between consumers and suppliers in the industry, and re-establishing trust in providers. He also calls for individual physicians to join in the movement, maintaining that these principles apply to individuals and small systems alike.

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