Clinical quality management in the combat zone: The good, the bad, and the unintended consequences

Clinical quality management (CQM) is a fixture of modern U.S. healthcare to include fi xed military medical treatment facilities. CQM is now being applied to the battlefi eld. In a related fashion, standards of care have been proposed in the context of combat medicine. The overall goal is to improve the medical care of casualties. Despite good intentions, the concepts and execution of CQM and standards of care are neither well-described in the literature nor established in official military doctrine and regulation. This has resulted in variable and haphazard applications that range from the positive and supportive to the negative and counterproductive. This article outlines the use of CQM in combat operations and asserts that a deliberate analysis of the benefits and risks is needed before its continued use. Future directions should focus on the impact of CQM on mission, doctrine, training, staffing, and unit organization. Rigorous adherence to evidence of effectiveness is essential before applying CQM in the combat zone.