TQM has been a prevalent business research issue since the mid to late 1980s. Available research regarding this type of organizational change has been conducted mostly in the private manufacturing sector. However, public institutions such as Canadian hospitals have also been jumping on the TQM bandwagon to battle organizational inefficiencies and shrinking government budgets.  The purpose of this research is to advance research already conducted in the Canadian health care industry with regard to TQM implementation, by identifying the similarities and differences between TQM literature and TQM implementation in hospitals. This objective was achieved by adapting the models of TQM implementation proposed by Kaltsounakis (1995) and Radnay (1997) into a proposed TQM implementation framework. The variables within this proposed model were examined for their applicability in three Canadian hospitals undergoing a quality initiative. Additionally, the differences between TQM theory used for the private manufacturing sector and its application in the context of public hospitals is discussed.  A multiple case design was used for the purposes of this study, as little research has been conducted on the issue of TQM in health care so far. Three hospitals served as research case sites--two were located in the province of Quebec, and one in Ontario.  Findings showed that TQM variables identified in the theoretical literature can be applied to a hospital environment in which TQM initiatives are undertaken. Specifically, 11 critical variables were identified in the final framework for TQM implementation in a Canadian health care context. These variables included leadership, quality planning and structure, supplier relationships, organizational commitment to TQM, organizational culture, quality activities, evaluation and follow-up of the initiative, and TQM success. Inhibitors of successful TQM implementation were also discovered. Implications for future research and practical applications of the findings were subsequently discussed.