title: Quality management within a cost-constrained service.
abstract: OBJECTIVE
  To examine the meaning of quality and ways in which quality can be improved despite budgetary limitations.
  
  
  RESULTS
  Definitions of quality are discussed, comparing the development from industrial concepts of quality to that contained within the Department of Health's A First CLASS SERVICE: The relationship of cost and quality is examined and the effects of changing treatments on healthcare costs explored. Clinical error is identified as a cause of increased cost through failure to maintain quality. A variety of quality tools are discussed in identifying ways in which quality can be improved within a cost-limited service. Thrombolysis is used as an exemplar and the effects on nursing discussed.
  
  
  CONCLUSIONS
  There is research evidence which demonstrates that some areas of quality are amenable to improvement despite budgetary constraints.
authors.affiliation: School of Nursing Studies, University of Central England, Birmingham, UK.
authors.forename: T G
authors.initials: TG
authors.lastname: Badger
mesh_terms: D002017:Budgets; D003363:Cost Control; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D019300:Medical Errors / Q000191:economics; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D019057:Quality-Adjusted Life Years; D013222:State Medicine / Q000458:organization & administration; D015912:Thrombolytic Therapy / Q000191:economics / Q000379:methods / Q000523:psychology; D017749:Total Quality Management / Q000458:organization & administration*; D006113:United Kingdom