The longer the medical bureaucrats delay, the more medical misadventures will occur in Quebec emergency departments and the louder will be the outcry from coroner's inquests, the public and physicians more concerned with emergency care than with medical politics.
for age and sex has diminished by 25% in the past 15 years. In so far as can be determined this is the greatest decrease in the shortest period in Canadian recorded his-
tory. This decrease in the annual death rate is certainly not due to improved economic conditions or to an improved environment, beGarth Dickinson, MD, FRCPC cause the economy and the enviCairo, Egypt ronment have not improved in the past 15 years. It is due to Reference health care, both curative and pre1. Royal College of Physicians and Sur- ventive. By this standard we have geons of Canada: Report of the Task achieved the most dramatic imForce on Emergency Medicine, 1988, provement in the quality of health RCPSC, Ottawa, 1988: 21 care in our history. Similar approaches can be taken to measure the prevention of permanent disability and of Achieving quality of care disease as well as the enhancement of well-being. W rith regard to the article "Quality of care: Mark A. Baltzan, MD, FRCPC, FACP 1. What is quality and Saskatoon, Sask. how can it be measured?" (Can Med Assoc J 1992; 146: 2153- The article by the Health Services 2158), by the Health Services Re- Research Group is timely and of search Group, Sunnybrook Health great interest, not only to CanScience Centre, I believe that to adians but also to Americans. achieve health care of high quality Health care in the United States is the health care system must meet in a double crisis: it is expensive, its objectives. The degree of suc- and it is not as good as it should cess it has in meeting its objec- be. Cost is easily measurable, but tives is a measure of the degree of quality is more difficult to assess. An evaluation of the quality quality that it provides. From the public's point of of health care would be simple if view the most important service it could be reduced to an analysis the health care professions offer is of the end results: those practithe prevention of premature tioners who had achieved the best death; the second is the preven- clinical outcomes would be astion of permanent disability; the sumed to have provided highthird is the prevention of disease; quality care. However, this would the fourth is the promotion of unfairly leave out of consideration well-being, not simply the elimi- other factors in the process of nation of disease; the fifth is the care. For example, physicians relief of suffering when nothing treating severely ill patients, even else can be done; and the sixth is with superb care and dedication, the transmission of knowledge. may not look as good as those The prevention of premature treating patients at lower risk if death is easily measured. Accord- the end results alone were being ing to the Bureau of Chronic Dis- compared. ease Epidemiology, Laboratory One of the references cited by Centre for Disease Control, Otta- the Health Services Research wa (personal communication, Group concerned the automotive 1992), the death rate standardized industry.' At first glance this in-
NOVEMBER 1, 1992
dustry may not seem to have much in common with the health care system, but both are measured in terms of quality. W. Edwards Deming, a champion of industrial quality, proposed a solution to the problems of quality and productivity in the US automotive industry. Detroit was not ready for him, and he took his theory to Japan. The Japanese accepted Deming and applied his principles, which simultaneously improved the automotive industry and transformed Japan into a world economic giant. Deming's proposed combination of improved quality and productivity had been considered incompatible in the United States. Americans must learn, too, how to improve the delivery of health care. The problem in medicine, however, is that we do not practise enough prevention, and there is no incentive to deliver better, less expensive health care. We know how to do it and what's required. We must show people that they can receive the excellent, affordable health care they deserve. Stefan Seimchyshyn, MD, FRCSC, FACOG Summit, NJ
Reference 1. Deming WE: Out of the Crisis, MITCAES, Cambridge, Mass, 1986: 23-24
The Health Services Research Group has attempted to define quality of medical care and pointed to the increasing importance of quality assurance. Nevertheless, many physicians remain antipathetic to the concept of quality assurance, partly because they view it as politically or economically motivated' and partly because there is an aura of mystique and obscurantism surrounding quality-assurance jargon. Yet for clinicians, striving for quality of care is the essence of the therapeutic enCAN MED ASSOC J 1992; 147 (9)
1305
for age and sex has diminished by 25% in the past 15 years. In so far as can be determined this is the greatest decrease in the shortest period in Canadian recorded his-
tory. This decrease in the annual death rate is certainly not due to improved economic conditions or to an improved environment, beGarth Dickinson, MD, FRCPC cause the economy and the enviCairo, Egypt ronment have not improved in the past 15 years. It is due to Reference health care, both curative and pre1. Royal College of Physicians and Sur- ventive. By this standard we have geons of Canada: Report of the Task achieved the most dramatic imForce on Emergency Medicine, 1988, provement in the quality of health RCPSC, Ottawa, 1988: 21 care in our history. Similar approaches can be taken to measure the prevention of permanent disability and of Achieving quality of care disease as well as the enhancement of well-being. W rith regard to the article "Quality of care: Mark A. Baltzan, MD, FRCPC, FACP 1. What is quality and Saskatoon, Sask. how can it be measured?" (Can Med Assoc J 1992; 146: 2153- The article by the Health Services 2158), by the Health Services Re- Research Group is timely and of search Group, Sunnybrook Health great interest, not only to CanScience Centre, I believe that to adians but also to Americans. achieve health care of high quality Health care in the United States is the health care system must meet in a double crisis: it is expensive, its objectives. The degree of suc- and it is not as good as it should cess it has in meeting its objec- be. Cost is easily measurable, but tives is a measure of the degree of quality is more difficult to assess. An evaluation of the quality quality that it provides. From the public's point of of health care would be simple if view the most important service it could be reduced to an analysis the health care professions offer is of the end results: those practithe prevention of premature tioners who had achieved the best death; the second is the preven- clinical outcomes would be astion of permanent disability; the sumed to have provided highthird is the prevention of disease; quality care. However, this would the fourth is the promotion of unfairly leave out of consideration well-being, not simply the elimi- other factors in the process of nation of disease; the fifth is the care. For example, physicians relief of suffering when nothing treating severely ill patients, even else can be done; and the sixth is with superb care and dedication, the transmission of knowledge. may not look as good as those The prevention of premature treating patients at lower risk if death is easily measured. Accord- the end results alone were being ing to the Bureau of Chronic Dis- compared. ease Epidemiology, Laboratory One of the references cited by Centre for Disease Control, Otta- the Health Services Research wa (personal communication, Group concerned the automotive 1992), the death rate standardized industry.' At first glance this in-
NOVEMBER 1, 1992
dustry may not seem to have much in common with the health care system, but both are measured in terms of quality. W. Edwards Deming, a champion of industrial quality, proposed a solution to the problems of quality and productivity in the US automotive industry. Detroit was not ready for him, and he took his theory to Japan. The Japanese accepted Deming and applied his principles, which simultaneously improved the automotive industry and transformed Japan into a world economic giant. Deming's proposed combination of improved quality and productivity had been considered incompatible in the United States. Americans must learn, too, how to improve the delivery of health care. The problem in medicine, however, is that we do not practise enough prevention, and there is no incentive to deliver better, less expensive health care. We know how to do it and what's required. We must show people that they can receive the excellent, affordable health care they deserve. Stefan Seimchyshyn, MD, FRCSC, FACOG Summit, NJ
Reference 1. Deming WE: Out of the Crisis, MITCAES, Cambridge, Mass, 1986: 23-24
The Health Services Research Group has attempted to define quality of medical care and pointed to the increasing importance of quality assurance. Nevertheless, many physicians remain antipathetic to the concept of quality assurance, partly because they view it as politically or economically motivated' and partly because there is an aura of mystique and obscurantism surrounding quality-assurance jargon. Yet for clinicians, striving for quality of care is the essence of the therapeutic enCAN MED ASSOC J 1992; 147 (9)
1305
