TQM : fad or fixture? Implementing total quality management in health care setting through the development and use of customer-supplier models

This research study reviews the global advances made in health care quality assurance, tracing its origins from the manufacturing and service industries through to the context of the health care industry. The Total Quality Management (TQM) model, originally adopted by the industrial sector is investigated as a possible paradigm for the health sector. Customer-supplier modelling, a novel methodology founded on the TQM philosophy is developed and applied to a hospital setting to test whether it can provide the framework for inter-disciplinary quality improvement. In essence this thesis examines whether it is possible to implement a quality assurance system in a large London teaching hospital based on the TQM philosophy, and whether the development of customer-supplier models can provide the framework for coherent, interdisciplinary, continuous quality improvement. Application of the models is found to be particularly relevant and beneficial to the clinical directorate - the front end of health care delivery - and examples are given at both macro and micro level. In particular, practical application issues are highlighted which include the importance of leadership from the clinical director, support from medical doctors and the role of the quality facilitator. But tantamount to all these requirements is team working, without which Total Quality Management can never be achieved. The benefits of customer-supplier modelling are shown to promote inter-disciplinarity, genuine dialogue, co-operation and an holistic approach to health service provision. This research has shown that an inter-disciplinary, systems approach to quality improvement, based on the use of customer-supplier modelling and the quality assurance cycle, provides a frame-work for the identification, analysis and solution of quality problems which involves both internal and external customers and suppliers. The results from this research have contributed towards the goal of inter-professionalism and genuine dialogue with the customer. This thesis concludes by recommending that there is a real requirement to look towards developing more participative ways of involving clients in the definition, evaluation, monitoring, supervision, production and reformation of health care quality and health care delivery systems