Modern quality management programs use continuous improvement process models to improve processes and services. The first step in the continuous improvement process involves understanding customer needs. Understanding customer needs is the basis of all quality management programs. Customers include all external customers, internal customers and suppliers affected by the service. Many managed care organizations evaluate customer needs through surveys. The second step involves identifying and evaluating the processes and outcomes that meet the customer's needs. Managed care organizations must evaluate access to services and the appropriateness of care provided to members. The third step of continuous quality improvement involves evaluating performance against a professional standard (Kongstvedt, 2013). Performance evaluation is carried out through suitability review, peer review and benchmarking. The main difference between peer review in a traditional quality assurance model and a modern quality management program is the topic of comparison (Kongstvedt, 2013). The fourth step of continuous quality improvement is to outline indicators to measure performance. The organization can apply the structure, process and outcome criteria when defining the indicators. The fifth step is to establish performance expectations. The first three phases of the continuous improvement process help define the organization's performance expectations. The sixth step of continuous quality improvement is performance monitoring. Performance is evaluated and compared to expectations. The seventh step is to provide feedback. Feedback is provided through profiling and report cards. The last step of continuous quality improvement is