Deming meets Braverman: toward a progressive analysis of the continuous quality improvement paradigm.
The continuous quality improvement (CQI) model has rapidly become the dominant management paradigm in U.S. industrial and health care leadership circles. Despite its widespread corporate acceptance and its relevance to public sector policy issues, there has been a paucity of progressive analysis of CQI. The authors begin by noting remarkable similarities between CQI critiques of Taylorism (so-called scientific management of work) with those made by Braverman, a leading Marxist analyst of the work process. Each of the 14 principles of CQI pioneer W. E. Deming are explained and analyzed for their progressive content. These pluses are then contrasted with 18 problematic issues in an attempt to challenge and go beyond the constraints of CQI as it is currently being applied in health care and other sectors. These issues include (1) mismatch between rhetoric and reality, (2) public sector issues, and (3) broader contradictions. The authors emphasize the genuine need for improving health care quality and the relevance of CQI for addressing this need. They challenge progressives to grapple with the profound contradictions by the CQI paradigm inviting a broader dialogue on CQI's meaning for improving the public's health.
Schiff
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General Medicine Clinic, Cook County Hospital, Chicago, IL 60612.
Goldfield
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D003695:Delivery of Health Care / Q000592:standards* / Q000639:trends; D005069:Evaluation Studies as Topic; D005544:Forecasting; D006801:Humans; D008332:Management Quality Circles / Q000639:trends; D017146:Models, Organizational; D011057:Politics; D011209:Power, Psychological; D017749:Total Quality Management / Q000639:trends*