‘Doctors bury their mistakes’ is a truism that may be one reason why clinicians have never really taken organisational quality seriously. However, one aspect of quality, i.e. trying to enhance patient safety (zero error rate) is very trendy at the moment, and fits with the medical aphorism, ‘primum, non nocere’ (first of all, do no harm). This concept of ‘fit’ is vitally important. It means that the effort directed towards improvement must mean something to the people who actually do the productive work, i.e. the clinicians.
Any model of TQM includes a monitoring function, i.e. how are we doing? Sometimes, doctors are blasé about outcomes (except when doing research, stangely enough) preferring to look ahead to the next patient rather than pondering about the last.
However, if you can link activity to outcome in a simple, automatic and timely way, you have the makings of useful feedback.