This paper identifies organizational barriers to quality improvement in medical and health care or ganizations. Quality is now recognized as one of the most challenging issues of the 1990s. The push for quality improvement rests on the significant assump tion that large and small medical and health care organizations will engage in quality assessment and assurance. Both researchers and practitioners must consider the organizational barriers the quality movement will encounter, particularly those major impediments to be overcome in the next 5-10 years. This paper organizes the analysis of organizational barriers to quality assessment and assurance accord ing to a five-part systems model of the organization. The barriers are categorized as technical, structural, psychosocial, managerial, and goals and values. Fol lowing a mapping of the barriers, education, training, and research and development needs to support qual ity improvement are identified.
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