Managing Change for Health Information Professionals (MCHIP)  

Total Quality Management (TQM)

Total Quality Management (TQM, otherwise known as Continuous Quality Improvement, CQI), encompasses the idea of an integrated programme of improved organisational performance at all levels, rather than depending on idiosyncratic brilliance. The idea developed in Japan in the 1960’s, and by the 1990’s had spread to America and Europe. It has four main assumptions:

• Success depends on all departments meeting the needs of its customers, including internal customers (other departments within the organisation)

• Quality and process are linked in complex but comprehensible ways

• Most workers do take pride in what they do, and are motivated to strive to better themselves.

• Fairly simple data collection and analysis can still yield useful insights into the causes of under-performance. 

Many people regard TQM as a managerial tool, designed to influence outputs or performance. However,  the technique also has well defined planning and analysis components, which can prove useful  in a change management programme.

Such aspects of implementing a TQM programme which are relevant to change management include:

• Pro-active management, which not only sets goals, but encourages and trains the workforce to improve processes, establishes a “learning environment,” and shows commitment form the top.

• Using techniques like brain-storming, flow charts, cause-and-effect diagrams.

• Explicit identification of internal and external customers

• Empowering and valuing staff

• Analysis of causes of  variation in the quality of both processes and outcomes

• Application of cross-functional teams to identify problems and suggest solutions

• Use of systematically collected data to identify problems and solutions

• Developing medium to long-term strategies and “mission statements.”

• Regarding quality improvement as a continuing journey, rather than a destination that will be fully achieved and then stopped.

This has the advantage that change is smoothed out into an incremental continuous process which is constant feature of working, rather than having the organisation lurch between alternating phases of torpor and panic.

The focus is on the process rather than individuals, but it often involves profound cultural changes in breaking down barriers between departments, which have traditionally had their own “patches,” traditions or work-practices to defend. Although all this sounds “sensible” the hard evidence that TQM works is limited: the technique is widely used in industry, but often rather loosely applied to local situations. Most studies published so far are descriptive case-studies rather than in-depth analyses, and the information offered to show that the outcomes of such programmes are positive is often anecdotal rather than systematic. The empirical evidence from health organisations is particularly thin, with some studies suggesting that clinicians do not make good team players in TQM programmes! The original Japanese model of TQM has also been modified to allow translation from a society which values loyalty and obligation, to Western ones, which may place more emphasis on rationalisation in problem solving.

Think about what the concept of “Quality” means in your organisation:

• How do you define quality?

• How do you measure it?

• Are there any systems to monitor it in place, and are they based on inspection, analysis of process or analysis of outcome / outputs?

• Are there any pro-active programmes to improve quality, or do you react to correct failures which generate complaints?