As total quality management becomes more ac cepted in health care organizations, it is apparent that organization-wide efforts will be needed to rein force and institutionalize these changes. This article stresses the importance of the direct involvement of the board of trustees in setting the climate for suc cessful interventions. The board must be open to using its influence on the system to facilitate changes. In addition, the board must be a part of the total quality management process. This article concludes with 10 guidelines for the implementation of TQM, each de signed to help ensure positive outcomes.
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