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Change approaches & management tools SeCtion tWo
Strengths and limitations
Applications of TQM approaches in care settings (health) have typically been disappointing, with little evidence of a relationship between TQM implementation and quality indicators such as length of stay, or clinical impact, or of staff empowerment. This is considered to be primarily due to the piecemeal implementation of the limited number of interventions and lack of focus on core organisational processes as required in the model. However care professionals appear to be reluctant to commit to the approach as its philosophy is perceived to be alien to their cultural expectations of work.
In relation to social care change, the language connected with TQM may be unfamiliar to stakeholders. The gathering and analysis of quantitative data may require new systems and training. The principles behind TQM are though a good fit with the principles of social care change.
Further reading
1. Berwick D, Enthoven A and Bunker JP (1992) Quality management in the NHS: the doctor’s role, British Medical Journal, 304, 235–39.
2. Berwick D (1998) Developing and testing changes in the delivery of care, Annals of Internal Medicine, 8, 8, 651–56.6
3. Crosby P (1989) Let’s Talk Quality, New York: McGraw-Hill
4. Deming WE (1986) Out of the Crisis, Cambridge, Mass: MIT.
5. Ishikawa K (1985) What is Quality Control? The Japanese Way, New Jersey: Prentice-Hall.
6. Joss R and Kogan M (1995) Advancing Quality: Total Quality Management in the NHS, Buckingham: Open University Press.
7. Shortell S, Levin DZ, O’Brien JL and Hughes EFX (1995) Assessing the evidence on CQI – is the glass half empty or half full? Hospital and Health Services Administration, 40, 1, 4–24.
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