Total quality management in hospitals

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Abstract
The health care industry in both the US and Canada has been under tremendous pressure to change and reform during the past decade. The pressure to change has been driven by escalating costs, and increased demands from both dissatisfied patients and third-party payers. A movement that holds great promise for improved health care quality and productivity is the introduction of total quality management (TQM ). Spurred by impressive results in other industries, this compelling and logical approach has begun to penetrate the thinking of health care accrediting agencies, business coalitions, private foundations and leading health care organizations. However, before making a commitment to TQM , hospital decision-makers should thoroughly understand what it is they are committing to, and what barriers they will encounter along the way. Hospitals face problems which are either unique or more severe than those of others. The most difficult barrier to implementing TQM in hospitals is their traditionally bureaucratic, complex and highly departmentalized structure with its ensuing culture and leadership style. Also problematic are (a) the unique relationship hospitals have with physicians, (b) the conflict between hospital management philosophies and TQM philosophies, (c) existing quality assurance programmes and (d) union-management relationships. This paper reviews several areas of potential conflict which may exist between hospitals' management and TQM .

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