TOTAL QUALITY MANAGEMENT IN HOSPITALS

The health care industry in both the US and Canada has been under trem endous pressure to change and reform during the past decade. The press ure to change has been driven by escalating costs, and increased deman ds from both dissatisfied patients and third-party payers. A movement that holds great promise for improved health care quality and producti vity is the introduction of total quality management (TQM). Spurred by impressive results in other industries, this compelling and logical a pproach 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, hospi tal decision-makers should thoroughly understand what it is they are c ommitting to, and what barriers they will encounter along the way. Hos pitals face problems which are either unique or more severe than those of others. The most difficult barrier to implementing TQM in hospital s is their traditionally bureaucratic, complex and highly departmental ized structure with its ensuing culture and leadership style. Also pro blematic are (a) the unique relationship hospitals have with physician s, (b) the conflict between hospital management philosophies and TQM p hilosophies, (c) existing quality assurance programmes and (d) union-m anagement relationships. This paper reviews several areas of potential conflict which may exist between hospitals' management and TQM.