managed by highly motivated individuals in institutions that voluntarily applied to participate.23

By contrast, a randomized controlled trial called Improving Prevention through Organization, Vision and Empowerment (IMPROVE) was conducted by two competing health maintenance organizations (HMOs) in the Minneapolis–St. Paul area to test the hypothesis that an HMO can use CQI to stimulate private primary care clinics to develop better delivery systems for eight clinical preventive services: blood pressure monitoring, Pap smear, cholesterol monitoring, tobacco use cessation, breast examination, mammography, influenza vaccine, and pneumococcal vaccine. Forty-four clinics were randomized with follow up involving 3,136 patients from the control clinics and 3,295 from the intervention clinics. The intervention was conducted between September 1994 and June 1996.

All 22 intervention clinics established improvement teams, and all training sessions received excellent evaluations. At the end, 94 percent of the 114 clinic team members reported being very satisfied or satisfied with their experience. Results showed no significant difference between intervention and control clinics on any of the clinical measures except for blood pressure. Except for two small differences between the intervention and control clinics, CQI failed to produce any significantly greater improvement in the intervention clinics during the trial. “Our study raises questions about whether CQI is the right model for making these changes.”24

Hazard Analysis and Critical Control Points25

Morrison Management Specialists, a member of the Compass Group, is a leading provider of food service expertise to the health care industry. Morrison services approximately 500 health care facilities nationwide, including hospitals, long-term care facilities, and senior dining communities. Mary Ivins, Director, Dining on Call, is responsible for Morrison’s program that provides patients with room service–style food delivery and for implementing and overseeing Morrison’s food safety policies and procedures.

Morrison’s use of HACCP is pivotal to minimizing foodborne illness risks and maximizing quality service. She sees the results from using HACCP as favorable but admits that Morrison’s biggest challenges are ongoing education and training of employees in proper food service procedures and simplifying the HACCP process.

Because many food preparation processes and subprocesses are similar, Morrison uses HACCP to identify as many hazards as possible throughout



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