QA activities based on this
approach have resulted in modest improvements in
health care quality, but they have several limitations
and drawbacks. The standards or thresholds are
inherently arbitrary and tend to become artificial
quality floors or ceilings. As such, they establish a
statistical tail, and improvement efforts are concentrated
within that tail. A good example of how an
arbitrary standard could limit quality improvement
is the report on surgical wound infections by Classen
et al