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Since the late 1980s, quality management, a concept that originated in the manufacturing and engineering sectors, has dramatically altered the political economy of everyday clinical practice. In a departure from prior conceptions, “quality” was reconstituted hierarchically as primarily the province of regulatory experts and epistemically as a narrow set of process-oriented metrics. As clinical guidelines have been assimilated into bedside medicine through regulated performance numbers, this powerful reconstitution has transformed the exercise of clinical judgment. Quality as “information” now encourages a form of clinical reasoning that is preferentially statistical and algorithmic in nature, eliding critical contributions from provider-patient relationships.
