QUERI – Quality Enhancement Research Initiative

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Quality Improvement Methods

52. Total Quality Management (TQM)

a. Definition:

Total Quality Management (TQM) is a structured approach to improving and maintaining quality utilizing an organization's entire team, including physicians. It contrasts with the quality assurance idea (QA) which is concerned with meeting specified standards. Important elements in TQM include the idea of continuous ongoing improvement and the involvement of employees working towards a common goal. As in Lean, Six-Sigma and other QI methods there is a focus on the customer or patient's determination of what constitutes quality. There is no universally accepted definition of the details of TQM which varies among the organizations adopting it. Particular tools of TQM include PDSA, identification of the patient's expectations, and quality standards which are discussed elsewhere in this handbook.

b. Literature:

  • Deming, W. Edwards. "Out of the crisis, Massachusetts Institute of Technology." Center for advanced engineering study, Cambridge, MA 510 (1986). Deming is generally credited as the founder of TQM and many of the ideas are represented in many QI methods.
  • Short, P. J. "Total quality management in hospitals." Total Quality Management 6.3 (1995): 255-264.

c. Example

A hospital wished to upgrade its ability to perform with high quality and involve the entire hospital staff in the process as well as provide a new image to the public. Several approaches were possible, such as pursing a Baldrige Award or getting an ISO 9000 certification, but TQM seemed to better fit their situation. TQM materials provided a structure and training content regarding how to improve and maintain quality. A challenge was the fact that TQM added to the already busy schedules of the staff and it was necessary to budget for such costs that this implies. TQM became the basis for the evaluation and rewards to management. The hospital used an incremental or PDSA approach to the rollout of the training and operational changes so that many aspects of TQM were implemented in various units over time. On an overall basis, TQM was used to measure, demonstrate changes in resulting quality.

d. Steps

A TQM approach to a QI effort might take a number of different steps. There seems to be no one agreed upon approach but the steps might be:

1. Management decides to use TQM as well as its key values.

2. There is an assessment of the organization's assesses current culture, patient satisfaction, and quality management system.

3. The organization determines customer demands and defines the products and services to meet those demands.

4. Critical processes to meet customers' needs are mapped

5. Teams execute process improvements

6. Managers contribute individually to the effort through Hoshin planning

7. Improvements result in implemented standard work descriptions

8. Progress is evaluated and the plan is revised as needed.

9. Ongoing employee awareness and feedback continues and a reward/recognition process maintained