of health care costs are issues that must be addressed by all health care institutions public and private sector. Budget reductions for the armed services and increased attention to the efficiency and effectiveness of governmentally provided services of all types are added pressures for military health care institutions. Improving 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 medical professionals, both civilian and military, 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 medical establishment suggest that a total quality management (TQM) program or one of the other programming approaches to quality improvement can lead to improved quality in health care (Banham, 1993, pp. 14 15). The concept of quality management has been applied in virtually every discipline, and medicine is the latest field of study to be subjected to quality analysis (Richards and O'Donnell, 1993, p. 2102).
The basic concepts of TQM and other programmistic approaches to quality management are compatible with the philosophical beliefs long and widely held within the American medical community (Jeffer, 1991, pp. 546 550). Thus, health care professionals are not being asked to adopt something that is alien to their disciplines when it is suggested that health care may benefit from quality management (Bell, 1992, pp. 132 136).
Nevertheless, the issue of quality management tends to be divisive among some groups of health care professionals (Solovy, 1993, pp. 14 19). The problem that must be addressed if qua...