Can quality management really work in health care?

Ten lessons learned by health care organizations can guide the industry's pursuit of total quality management (TQM). The lessons derive in part from the National Demonstration Project on Quality Improvement in Health Care and the Institute on Healthcare Improvement. First, top management and the board must commit themselves and resources to TQM. Executives should beware of overdelegation of quality tasks. Second, have a plan for combating problems of high turnover of executives and medical staff presidents. Third, know that it is easy for top management to become distracted once the quality effort begins. Fourth, involve physicians in TQM from the very beginning. Fifth, establish a structure that includes a quality council, quality director, trained facilitators, and a strategic planning process. Sixth, realize that TQM requires cultural change. Seventh, training sessions should lead to applications of what has been learned. Eighth, be sure that measurements are useful and that the data are effectively analyzed. Ninth, know that TQM can lead to improved financial return ratios. Tenth, customer focus is the key. (April 1992)