Total Quality Management and the Silent Patient
本文探讨了全面质量管理等商业技术在医疗保健系统中对患者关系的影响，指出其无法阻止甚至可能加剧对患者关注的转移，并推测组织伦理流程可作为质量控制机制来改善这一问题。
This essay examines the impact of the imposition of businesses techniques, in particular, those associated with Total Quality Management, on the relationships of important components of the health care delivery system, including payers, managed care organizations, institutional and individual providers, enrollees, and patients. It examines structural anomalies within the delivery system and concludes that the use of Total Quality Management techniques within the health care system cannot prevent the shift of attention of other components away from the enrollee and the patient, and may even contribute to it. It speculates that the organization ethics process may serve as a quality control mechanism to prevent this shift and so help eliminate some of the ethically problematic processes and outcomes within the health care delivery system.