The Practice of total Quality Management in the Clinical Setting.

The institution of Total Quality Management TQM at Tripler Army Medical Center TAMC is occurring in various stages. TAMC is implementing TQM using the FOCUS-PDCA methodology to improve performance throughout the facility. The use of this methodology assumes that some benefit will accrue. This paper examines the implementation of the FOCUS-PDCA methodology to determine if performance improvement techniques can be applied successfully at the unit level within TAMC to reduce patient waiting times. A participative observational study is used to analyze the effectiveness of TQM in the orthopedic clinic using a template adapted from the Hospital Corporation of Americas FOCUS-PDCA model. Results indicate that average patient waiting times decreased by 27 percent using the FOCUS-PDCA performance improvement methodology but barriers to implementation exist that limit the effectiveness of the model. Institutionalization of TQM can only be achieved through acceptance by both senior leadership and physician groups.