LDS Hospital in Salt Lake City has a computer system that records all procedures performed on patients and all drugs administered. The computer system can track which surgeons are the best and which ones are the worst in terms of length of patient stays, complications, and death rates. They found that once a new quality-improvement program was imposed after an extensive study of past practices, nearly all the doctors improved. But some did not.

The doctor in charge of the quality-improvement program said, "I have a few bad ap- ples. And I know who they are. But for quality improvement to work, you have to construct a ‘safe' environment where doctors trust you. Any time you start taking names, you're going to start a cycle of fear, and quality improvement will not occur."

When he learned of the LDS tracking system, the head of the Utah medical board said, "That's a terrible indictment of them and of the practice of medicine that they are willing to sacrifice patients to unnecessary mortality, morbidity, injury, and pain by these doctors. It's unconscionable!"

Discuss the dilemma LDS faces in terms of using its computer system to improve quality.