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To the Editor: The article by Dr Chassin and colleagues¹ notes that health care quality can be defined, that there is a need to improve quality, and that current approaches to quality improvement in health care are not successful. We agree with the authors' suggestions that continuous quality improvement techniques have been adopted slowly and that market pressures do not reward excellence in quality.

Continuous quality improvement seemed to be a catchy, feel-good movement of the mid-1990s that received much energy but little commitment from the health care industry. Its principles, practices, and results are not expected to be mastered in a short-term "project of the year" approach. In fact, we believe no short-term fix is attainable.

Quality in practice yields diminishing rewards. Facing economic challenges, "health care reform" became the rallying cry of this decade. Concerns and interest in quality took a backseat to "business principles." Issues of finance . . . [Full Text of this Article]