Medical practice is facing many pressures, all requiring ever-higher standards and better 'quality' in the provision of clinical care. Medicine is not alone in facing such forces, and it may be appropriate to apply the methodology used in other disciplines to address this issue; common problems are generally amenable to common solutions. The 'quality' approach was initially applied to health care in the USA, presumably because of the accent on market forces and the relationship with market share. In recent years, other health care systems have invested in this approach, applying lessons learned from management disciplines and the aviation industly. The Institute of Medicine's report on health care quality noted that 'every system is perfectly designed to obtain the results it gets' fll The European Union has thus far not included quality as a formal item on its agenda; however, with increasing mobility of patients and health professionals, there is pressure for legislative action addressing risk management and quality improvement. The development of a European approach to ensure the highest quality standards, free movement in the European Union, as well as the medical devices industry, are all areas that are raising interest. Overall, it behooves the individual clinician to be aware of developments in the area.peer-reviewe
