Over the past few decades, economic, legal, technological, demographic, and political changes in the social context of health care in the United States have produced significant modifications in perceptions and expectations of the health care system. The quality of care provided within health services institutions, encompassed within the catch phrase &dquo;continuous quality improvement&dquo; or &dquo;total quality management,&dquo; is a focus of much discussion and even a mandate by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Specific methods of quality improvement remain questionable; yet multidisciplinary collaboration and teamwork have been identified by most writers as vital components of the quality improvement process

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