It is difficult to change processes due to organizational culture. It is difficult to quantify incremental quality improvement outcomes. The continuous quality improvement approach aims at improving internal and external processes through the use of healthcare information. The merit of the approach is that it is based on quality assurance methods that support organizational systems. The demerit of the approach is that it takes a long time to implement (Kelly

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2007). The total quality management model uses a collection of management practices to improve the quality of healthcare outcomes. The merit of the approach is that it uses holistic quality improvement methods. However

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