the quality of the care provided is widely suggested in the 1990s as the solution to the problems being faced by health care institutions (Phipps, 1992, p. 10). While health care professionals have no quarrel with striving for high quality health care, many of these individuals do tend to reject initiatives that appear to be further manifestations of codified bureaucratic machinations that will have no long lasting positive impacts on the quality of health care services (Jeffer, 1991, pp. 546 550). Nevertheless, many theorists and observers both inside and outside the health care establishment suggest that a quality assurance program can lead to improved quality in health care (Banham, 1993, pp. 14 15). The concept of quality management has been applied in a wide variety of disciplines, and health care is the latest field of study to be subjected to quality analysis (Richards and O'Donnell, 1993, p. 2102). The basic concepts of quality mana
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