The CQI/TQM journey in France.

BACKGROUND: In France interest in continuous quality improvement (CQI) and other quality improvement (QI) approaches is recent and experience modest, but the pace of change should quicken now that the government has required that all hospitals be accredited within the next five years. In addition, in the face of increasing competition, hospitals, public and private, may find a quality strategy to be critical in helping them survive. A NATIONAL INCENTIVE FOR IMPROVEMENT: In fall 1994 the National Agency for the Promotion of Medical Evaluation (ANDEM) was mandated by the Ministry of Health to set up a national demonstration project based on quality assurance and CQI methodologies. The program was designed to identify the key success factors for implementing such programs within hospitals. The program involves 28 18-month CQI projects, which deal with prevention of nosocomial infection, patient safety in anesthesia, medical records, blood transfusion safety, drug dispensing safety, and control of violence in psychiatric settings. Participating hospitals are required to analyze the variation in the involved processes and attempt to reduce variation through cross-departmental quality management programs. The general method for each team's management of the project closely follows the PDCA (Plan-Do-Check-Act) cycle. Preliminary experience suggests that the participating hospitals have benefited from following the same model and sharing of accounts of their progress. Representatives of the 28 teams met in fall 1995 and June 1996, and future meetings are planned. Most of the teams have collected quantitative data about the current processes and have started to pilot test process changes.