Managing for program quality in a decentralized health care organization

A major issue for the Indian Health Service (IHS) in the 1990s is how best to assure quality of its health programs - both those that are delivered through federally-operated, but still very decentralized system of service units as well as the increasing number of programs operated by the Tribes. The purpose of this document is to describe the Indian Health Service IHS approach to managing for quality in the 1990s. The authors delineate the IHS Quality Assurance System -including its definition of quality, the principles on which the system is based, and how the system is intended to operate. The IHS has always been dedicated to bringing the professional culture of the U.S. health care system - a culture that includes accreditation, service standards, certification, quality assurance, peer review, and continuing education -to the health care systems that serve Indian people. This document, in one respect, is designed to codify the policies, principles, and lines of accountability on which that system has come to be based