Abstract
Total Quality Management (TQM) has been extensively adopted by many organizations but has not necessarily resulted in the desired levels of effectiveness. A large number of failures have been attributed to faulty implementation. This paper presents the results of a study of implementation processes in hospitals. It examines the role of vision, leadership, momentum of change, teamwork, availability of resources, focus, and training on the desired medical and financial outcomes. The paper also discusses the lications of the study for decision-makers.