The implementation of total quality management in hospitals: how good is the fit?

Total quality management has become popular among hospitals because of its promise to reconcile trade-offs between cost and quality. However, assumptions inherent in TQM may not translate to the hospital environment: hierarchical management control over the technical core and the dominance of rational decision making. This article considers these two assumptions and suggests that the application of TQM to hospitals take them into account because they may compromise its success.