title: Quality improvement issues in Brazil.
abstract: BACKGROUND
  In 1988 a new constitution in Brazil brought the creation of a national health system, the Unified Health System (Sistema Unico de Saúde; SUS).
  Accountability is not yet a strong feature of the health system, even though the Ministry of Health has made efforts to encourage the federal district and 26 states to participate in some quality-of-care projects. Initiatives include certification by the International Standards Organization (ISO; Geneva); consulting services, especially in managerial processes; total quality management; patient satisfaction; and development of new technologies to increase efficiency.
  Physicians' oft-repeated claim that they know all it takes to offer patients high-quality care makes it difficult to enlist their help in quality programs in general and in establishing protocols and guidelines in particular. State licenses are a prerequisite for hospitals, but this is not always enforced; the local health authority may be relieved that hospital care is at least being provided. Similarly, the government may find it important that the population has access to health services, even if the service is not considered adequate. Government can encourage quality initiatives and assess and disseminate the findings.
authors.affiliation: São Paulo Business Management School/Getúlio Vargas Foundation (Escola de Administração de Empresas de São Paulo da Fundação Getúlio Vargas), Brazil.
authors.forename: A M
authors.initials: AM
authors.lastname: Malik
mesh_terms: D001938:Brazil; D004059:Diffusion of Innovation; D006302:Health Services Research; D006801:Humans; D007348:Insurance, Health; D009313:National Health Programs / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D017749:Total Quality Management / Q000458:organization & administration*