The state of quality management in HMOs.

Interest in total quality management (TQM) in health care is increasing rapidly as leaders search for positive strategies to deal with both costs and quality. We conducted a national telephone survey of 200 HMO medical directors, 451 physicians affiliated with managed care organizations, and 550 corporate health benefits officers to obtain their reports of the potential contributions, the current interest in, and the degree of implementation of TQM activities in their own managed care systems. A large majority of all respondents felt that TQM could help greatly in health care, as it has in other industries. Among HMO medical directors, 81% claimed that their organizations placed "a great deal of emphasis" on TQM, while only 34% of physicians and 35% of benefits officers agreed. Areas of implementation claimed by the HMOs tended to involve abstract matters such as mission statements and leadership commitment, while technical components of TQM, including data systems, training, and supplier management, appeared much less well-developed. The managed care organizations surveyed seem to be in the early phases of commitment to TQM. To achieve the results seen in other industries, these organizations will need much deeper levels of investment, understanding, and deployment of TQM than this survey reveals.