There has been growing concern in the National Health Service (NHS) to improve aspects of health care since the early 1980s when the Griffiths Report (NHS Management Inquiry, 1983) placed explicit emphasis on quality as an agenda item. Since then serious attention has been given to the development of approaches and tools for the assessment of change with increasing pressure from the Department of Health to provide quality health care. As a result, a whole growth industry has evolved around the concept of “quality”, including quality assurance, quality assessment, quality control, and total quality management. And while considerable controversy surrounds the meaning of such terms, the general consensus is that the health service needs to focus on improving the quality of its health care to patients. There is less agreement on how this might be achieved. Nevertheless, quality health care together with total quality management (TQM) has emerged as a watchword for health care in the 1990s. This chapter discusses the relevance of total quality management, as it pertains to the health service.
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