Dynamic change characterizes the American health care environment in the 1990s (Hammonds, 1994, pp. 48 57). Within such an environment, care providers and support organizations must develop and implement new and effective strategies if they are to remain viable entities.
The changes in the health care environment result from a combination of factors increasing costs of health care, changing societal values, advances in treatment therapies, technological innovation, changing demographics, and many others (Nichols and Stevens, 1992, pp. 86 95). Cost is a major factor involved in changes in the delivery of health care delivery and support services. It is, therefore, imperative for health care delivery and support organizations to develop procedures that will lead to more effective and more efficient operations. The improvement of quality in all aspects of a health care institution's activities has been linked to this goal (Cleverly and Harvey, 1992, p. 40).
The need to improve quality and control costs is especially applicable to health care institutions receiving public financial support. Proposed national health care reform, increased consumer demands for quality health care, and public outcries for the control of health care costs are issues that must be addressed by all health care institutions in both the public and private sectors. Budget reductions and increased attention to the efficiency and effectiveness of governmentally provided services of all types are added pressures for health care
institutions receiving public funding. The development of effective approaches to the solution of the problems associated with this issue, however, is a difficult task.
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 have no quarrel with striving for high quality healt...