Total quality management in a hospital.

The adaptation of the management philosophy and tools of total quality management (TQM) to the modern American hospital, its staff, and physicians is a major challenge facing health care today. The TQM "bandwagon" is one that hospitals both want to--and are required to--jump on, insofar as TQM is now part of the revised Joint Commission standards [Ed note: The standards encourage hospitals to adopt TQM, continuous quality improvement, or a similar approach to improve performance]. TQM holds out the promise of improving clinical quality while simultaneously reducing the "cost of poor quality." Although the actual realization of cost savings through TQM remains to be seen, the author provides an exceptionally clear overview of the issues involved in TQM implementation at the hospital level. This article is noteworthy in its practical and experienced approach to the necessary groundwork for a successful TQM program, including strategic commitment, human resource issues, and oversight of the TQM process as it unfolds. Quality review professionals may still wonder how to merge hospital and medical staff quality assurance efforts with TQM initiatives in the near future.