Current quality assurance approaches will not be adequate to satisfy the needs for quality in the next decade. Quality management science (QMS), as evolving in industry today, provides the dynamic framework necessary to provide continuous improvement of quality. QMS emphasizes the importance of defining quality goals based on the needs and expectations (implied needs) of customers. The laborato...

Accepted for publication 18 November 1996 Introduction Hospitals increasingly wish to know how well they are performing and to have effective means of assessing and improving the quality of care that they provide. For this they require measures that are meaningful, interpretable, and of demonstrable value in helping to improve quality. One potential approach is the use of quality of care indica...