Janet A Brown. (Pp 800; $125 for NAHQ members, $140 for non-members, yearly updates available for additional fee). California: Managed Care Consultants, 2000. (Also available through the National Association for Healthcare Quality (NAHQ), P O Box 3781, Oakbrook, Illinois 60522, USA.)Quality in Health Care 2001;10:128

Revised yearly since 1986, this is an 800 page loose leaf handbook in a ring binder and is used by some readers to prepare for the International Certified Professional in Healthcare Quality (CPHQ) examination of the Healthcare Quality Certification Board which is associated with the National Association for Health Quality (NAHQ).

Imagine a classmate of yours known for taking meticulous notes for all her classes and homework. Imagine that she kept such notes for the equivalent of a master's degree in health care quality and she kept reading and updating these notes for 15 years. This may give you an idea of what Janet Brown has written. The result is a book too heavy to hold in your hands for long. There are lots of definitions, lists, and bullet points summarising the literature. These references are cited. Brown's outline approach allows a lot of densely packed information to be included; there are proportionally few full paragraphs. Three hundred and fifty multiple choice questions are included to test your knowledge and prepare for the CPHQ examination.

About 20% of the content is specific to laws and institutions in the USA such as the requirements of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). Some of this may be of interest to experts outside the USA. The other 80% is quality theory and principles and is applicable anywhere.

The book is divided into sections on quality concepts, strategic leadership, quality system management, performance improvement, information management, people management, and USA federal legislation related to quality. Here is a haphazard sampling of concepts to be found in the book: factors affecting utilisation, Deming's 14 points, risk management, benchmarking, team leadership skills, clinical pathways, case management, medical records review, medical staff appointment process, quality indicators, the European Foundation for Quality Management award criteria, affinity diagrams, the “five whys”, FOCUS-PDCA, and the list goes on. The density of information in this practical handbook is such that it makes any other book on health care quality published in the last decade seem undernourished and anaemic. The most similar book known to this reviewer is the 778 page textbook by Goetsch and David entitled Quality Management: Introduction to Total Quality Management for Production, Processing and Service, 3rd edition, published in 2000 by Prentice Hall. This is a basic general class room textbook for management students and is a companion more than a competitor to Brown's handbook.

In a personal communication with Janet Maronde, Executive Director of the Healthcare Quality Certification Board, she informed me that since 1984 the CPHQ examination has been taken by 13 000 people and 9500 have been certified. For the first time in the year 2000 it has become international. It is given in many locations around the world and the content specific to the USA has been nearly eliminated. Maronde was careful to say that her Board does not recommend any particular textbook to prepare for the CPHQ examination, but that many people use Janet Brown's handbook for this purpose.

No errors of commission were found in the handbook. Although the pages are not numbered, the chapters and paragraphs are. This, and the lack of an index, make inserted revisions easier. Given the size and density of the handbook, it seems unfair to ask for more. This reviewer would like to have seen more on statistical process control. Perhaps European readers would like more on ISO 9000 and its updates, even though this approach is not widely used in USA health care. The section on reduction in medical errors will no doubt be expanded in future revisions, but this literature in health care is just beginning.

This unique handbook should be available to every health care quality professional who wishes to recognise and have access to the large body of ideas and methods now available for improvement. It should become available on computer disk in the future.