h care, many of these individuals do tend to reject initiatives that appear to be further manifestations of codified bureaucratic machinations that likely 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, such as continuous quality improvement (CQI) 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 is both relatively new and controversial (Atchison, 1992, p. 15). Most of the applications of quality management concepts have been in organizations operating in other than health care environments. Observers within the health care establishment have noted, however, health care can learn from other fields with respect to the pursuit of quality (Feigenbaum, 1992, p. 56). There is every reason to believe that health care delivery institutions may benefit from the implementation of quality management programs, and that patient satisfaction at such institutions will be improved throu...