Gatekeeping.

Much has been written about the strengths and weaknesses of quality assurance (QA) and continuous quality improvement (CQI) as approaches to achieving optimal quality and value in health care. In the past, the motivation behind QA was largely regulatory. Today, the driving force for CQI is corporate America, whose clout has key provider constituencies ready to cooperate as never before. This article argues that many of the functions of traditional QA will remain an integral component of quality management strategies for health care organizations and that the success of these efforts will depend on a coordinated effort by professionals from QA, quality management, and health services research. Furthermore, quality engineering concepts from other industries provide a useful framework to enable coordination among these three fields.

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