Total Quality Management
Total Quality Management is a concept that seeks to incorporate all the functions of an
organization in order to focus on achieving all the needs of a customer. The TQM philosophy
began in the early 1950’s and its original objective was to provide the services and products that
the customers needed. The key policies of TQM are enshrined in the belief that the management
must strive always to improve the processes that make up an organization.
The first step in implementing a TQM system in a health facility is to assess the establishment
critically to ensure that the need and urgency of change is quite clear and the best strategy to
adopt is the TQM system. The history of the establishment must be sought in order to understand
the preconditions that the health care institution is in and the precipitating events that led to the
needs for TQM solutions.
The basic steps in implementing and managing involve the identification of the task to be done
and creating the necessary structures that are required to develop the system. The method of
communication must also be carefully designed to avoid fallout in certain departments. For
example, if the management decision is to merge the junior nurses section with the other
cleaning department to ease management responsibilities it should be clearly explained the that
Total Quality Management 2
their expertise would be taken care off in terms of the pay compensation to avoid any feelings of
degradation (Bellack, Gerrity, Moore, 1997).
After identifying the tasks required, then the management has to assign the required resources.
TQM is basically concerned with the principals of Continuous improvement which entail intense
training in strategic planning and clear decision making processes. The results of past
performances must always be reviewed with the major aim of improving the past performance.
This exercise ensures constant improvement in workers capabilities, machines, technology and
production processes (Hunter, Kernan and Grubbs, 1995).
The major processes in a health institution are mainly in the provision of services which are done
by the consultants and surgeons but the administrative duties may present a challenge to the
management in cases of complex and large hospitals. But the common areas that need constant
evaluation are mostly on the casualty wing that deals with emergencies and the records and
insurance section that requires trained personnel to avoid critical mistakes (Colton, 1997).
The future of CQI is mostly related to the growing needs for improved performance however
integrating the system into a competing sphere where demands of work, personal life, family and
spiritual needs all fight for space in the contemporary world, CQI faces a major challenge in its
successful implementation in future. Also every aspect of management involves marginal and
opportunity costs which must all be considered before the implementation of any operation.
TQM central principle is that major mistakes are either made by people but most of them are
generally caused or allowed to happen by the weak and faulty systems (Hyde, 1992). If the root
causes can be identified and addressed then future occurrence can be minimized or even totally
eradicated. Proper TQM may actually reduced the cost of health care services in the world today
if all the functions of the health care providers are optimally managed and the consulting
Total Quality Management 3
surgeons find themselves in well coordinated working environments where services are well
coordinated and where the guiding principles are commitment to the tenets of CQI where hard
work and honesty prevails. In Michigan, the university hospital developed a CQI where the
pursuit of excellence, efficiency, compassion and integrity are the guiding principles of the
hospital (Berglund, 1995). Proper implementation of the TQM principles can lead to improved
health care services that are affordable.
Bellack, J.P, Gerrity P, Moore, S.M. (1997) Taking aim at interdisciplinary education for continuous
improvement in health care, Nursing and Health Care Perspectives, 1997; 18(6):308-315.
Berglund, R.G. (1995) University of Michigan Leadership: Creating the quality culture, Presented at
the Michigan Quality Council1994 Leadership Awards; March 20–21, 1995; Troy, MI.
Colton, D. (1997) The design of evaluations for continuous quality improvement. Evaluation & the
Health Professions.1997; 20(3):265-285.
Hunter, D.L., Kernan, M.T. and Grubbs, M.R. (1995) Team works: a model for continuous quality
improvement in the health care industry. American Journal of Medical Quality1995;
Hyde, A. (1992). “The Proverbs of Total Quality Management: Recharting the Path to Quality
Improvement in the Public Sector.” Public Productivity and Management Review, 16(1),