Japanese healthcare quality improvement

Are there lessons for the West from the way Japanese managers and healthcare workers use quality methods in healthcare? This paper describes the Japanese approach to quality in healthcare by drawing on a research visit and published research. It describes the similarities and differences between Japanese and other public healthcare systems and the factors leading to the application of quality methods in Japan. The paper discusses why quality methods have been used less in healthcare than in industry, and the methodology of quality circles. It describes why total quality methods have not been adopted, the approach of "evidence based participatory quality improvement" which is being developed and proposes that western healthcare can learn from the methodical "bottom-up" introduction of quality methods as a foundation for TQM.