The perceived effectiveness of Total Quality Management as a tool for quality improvement in emergency medicine

Objectives: To describe the perceived effectiveness of using the Total Qual ity Management (TQM) approach to quality improvement in both academic and n onacademic EDs, and to discuss some important barriers to effectiveness of TQM programs. Method: A mail survey of 100 EDs was conducted with telephone follow-up. Hospitals were randomly selected from three subgroups: universi ty teaching hospitals, nonuniversity teaching hospitals, and private nontea ching hospitals. ED physician directors or nonphysician administrators with knowledge of departmental quality improvement initiatives were surveyed. R esults: The overall response rate was 60%. Of the respondents, 54 (90.0%) u sed TQM techniques as part of their quality improvement initiatives. TQM te chniques were used more frequently and for a longer duration in academic pr ograms. ED staff participation in TQM projects was relatively low; less tha n 25% in the majority (79.6%) of all EDs. TQM initiatives were ranked least effective in university settings, of which 11 of 13 (84.6%) rated their TQ M programs as ineffective or having no effect. More mature programs (>5 yea rs old) had a significantly higher ranking for effectiveness than those pro grams less than 2 years old. Conclusions: Total Quality Management is being utilized in a large number of EDs. TQM initiative is perceived as having l ittle or no positive effect. This is particularly the case in academic EDs.