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Dr Deming and Primary Care Internal Medicine

Bruce D. McCarthy, MD, MPH; Richard E. Ward, MD, MBA; Mark J. Young, MD
Arch Intern Med. 1994;154(4):381-384. doi:10.1001/archinte.1994.00420040033006.
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THERE HAS been increasing attention given to the principles of continuous quality improvement (CQI), often referred to as total quality management (TQM), as a means to address the perceived problems of variation in and concerns about quality in health care.1-3 Continuous quality improvement is derived from industrial qualitycontrol techniques first developed by Shewhart,4 working at the Western Electric Co in the 1920s. W. Edwards Deming, PhD,5 a statistician, introduced these concepts to Japan in the 1950s and is considered one of the heroes of the revitalization of Japanese industry.6

The aim of this report is to describe, through the use of clinical vignettes, a vision of primary care internal medicine that would provide a clinician with "joy in work. "5 The major theses are (1) that the principles of continuous quality improvement championed by W. Edwards Deming, PhD, and others may provide the tools and conceptual


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