Abstract

Total Quality Management (TQM) has become something of a social movement in North American organizations over the last decade. Over the last few years, it has also had a tremendous impact on the management of health care organizations. Using a multiple case study method, this research examines TQM's implementation in health care organizations. It begins with research questions that ponder the unique circumstances of health care organizations and an hypothesized paradigm for TQM health care organizations that were derived from an extensive review of the literature. Data from focused interviews, participant observation and existing documents were used to compare the hypotheses to the TQM experiences of the three case hospitals. The qualitative results support the research questions and guide the development of the final paradigm. As hypothesized, all original TQM variables were used in the health care organizations, two new TQM variables were identified and TQM was found to be implemented by the health care organizations tectonically, in small incremental steps. The final paradigm details these findings. The research also lead to the development of a model for the stages of TQM change in a hospital and serves to strengthen TQM's construct validity. The implications of these findings for health care organizations, and for TQM theory and practice are discussed. Future research suggestions are also provided.