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What went wrong with TQM?

By Rebecca Anwar, Ph.D.

Total Quality Management – TQM. We know it well. It gripped the American workplace and crept into the health care industry in the early nineties. It was, and in some cases still is, the latest rage. From the onset, there was a lot of hype and acceptance of TQM. For many health care businesses it resulted in a commitment and an investment. They went on to retool operations, increase efficiency and improve “quality.” Though some hospitals and medical practices continue to endorse and espouse the success of their TQM program, many have all but forgotten the efforts and investment made.

What went wrong? Here we are in 1996 and the enthusiasm for TQM has fizzled. Despite a sincere interest in providing quality product and service, some small to mid-sized health care organizations never got off the ground floor. For others, a considerable amount of time, energy and money was invested to develop and support a TQM program that would improve management, increase efficiency and foster team spirit. Yet, in time, programs lost momentum and the current status and success of TQM is questionable for many health care organizations.

Why is it that health care has not experienced overwhelming, “long term” success with TQM? At the risk of offending TQM advocates, the following assessment is presented.

TQM – A Great Idea

The concept of TQM is fantastic: involve the people, examine their work flow and develop ways to improve the output, thus eliminating waste. By including staff and gathering input from everyone involved in a procedure, we are able to collectively examine the function (purpose) and flowchart the process (action taken). We can quickly identify and eliminate wasted steps and duplication. We are on the way to improving quality. So what could possibly get in the way of our success?

Time Consuming and Laborious

Designing a structured TQM program includes the development of “teams” and the unfortunate necessity of many meetings. And this is where the problem begins. The idea of the flowcharting and streamlining process was to eliminate steps and time. Now time is spent meeting with other team captains, documenting progress and monitoring performance. Team captains may have been assigned who may not be as committed to the TQM concept (and the investment made) as top management. In addition, the team may change. People leave the organization after we involve them and invest time in their training.

Expecting Too Much Leadership

Our team captains may be great on the line, and, in fact, they climbed right on the bandwagon with TQM. That doesn’t mean they are natural leaders. After a year or so, it is possible that the excitement has waned. They have other things on their minds and don’t want to be involved any longer as a team captain. They don’t want the responsibility they have assumed. They have seen people come and go and haven’t been able to generate enthusiasm. This has been discouraging and has eroded their confidence. Some of our team captains are well-intended, but are unable to succeed in a leadership role.

Attrition and Change

The original team received extensive training with the TQM plan. They worked with great gusto to set up a promising program. They enjoyed the fruits of early success. That was then, and this is now. There has probably been some staff turnover. It is likely that some people in the initial group have left the organization or are now working in another capacity. The people that came aboard since then really haven’t bought into the concept. In addition, with the evolution of managed care, your organization has changed in order to adjust to external and internal influences. Things just aren’t the same. This makes it exceedingly difficult to keep your TQM program going and to get new employees to “buy in.”

A Costly Investment

Hiring advisors, trainers and training tools to implement your TQM program was quite an investment. On top of that, consider the lost productivity with repeatedly bringing staff together to set up the program, identify problems and determine viable solutions. And then there are all those team meetings and the mechanics of documentation and follow-up essential to monitor actions and measure results. No question about it, TQM can be a high maintenance, costly program.

Can you really measure the gains achieved with your TQM program? Has the benefit exceeded the investment of time and money? Will the gains received be long-lasting, or is TQM simply the latest management rage?

The WISE Approach

There is a simpler way to achieve success with organizational management. The line people in an organization are critical to our success. We must respect them and appreciate them. They can help us keep a pulse on business operations. We don’t need complicated manuals and written guidelines defining function and process. It is a matter of recognizing each individual’s strength and appreciating their contribution. Setting up reporting mechanisms is important, but we will get automatic feedback and keep a pulse on our organization if we are wise.

The principles of sound management and efficient operation lie in the individuals. Each person’s contribution should be valued. Then we can examine the process and function. We must learn to watch the people in our organization and be skillful in recognizing their potential. Believe in your people and you will be able to inspire them to grow, produce and accomplish much more for your organization than you might have imagined. The value of the loyalty and dedication you receive is impossible to measure.

If you support and encourage your staff, the sky is the limit. They will take ownership not only for their performance, but also for the success of the company. Enjoy your work, enjoy your staff. They will feel it and they will help you succeed.

Here it is, and it’s all too simple. Rely on your human relations skills and the technical gains will follow. The concept is simple and there is little economic investment. Be a good coach, be a good cheerleader. Celebrate your success on a regular basis. Be WISE.


Pay attention, be observant. You can learn a lot about your people and a great deal about the organization. Too often, managers are caught up in the responsibility and the objectives they must accomplish. Stop it! Get in touch with your people. They are the link to your success. Recognize the problems they face. Have empathy and help them solve their problems. The problems aren’t yours to solve. Your job is to give people the tools to solve their own problems. You can do that by watching to see what changes they face, their approach to dealing with problems and by helping them gain perspective so they can achieve the desired outcome.

Start by giving them some “slam dunks” – easy wins. Deal first with problems easily solved and solutions easy to implement. Once they begin to see the results they can achieve, their confidence will grow. With the guidance of a good coach, they can excel and you will help them build incredible confidence in their own ability to solve future (more significant) problems.


This is not easy for everyone. It does require you to let go and have confidence that people will grow and expand their contribution. If you set limits on people, they will fall to your lowest expectation. Expect a lot from people, give them the confidence to accomplish more, and always stand behind them. Celebrate their successes and downplay their failures. Encourage them to pick themselves up and try again, giving constructive criticism to help them grow and expand their capabilities.


Your support will foster growth, team spirit, ownership in the organization and loyalty. You will increase productivity and quality beyond your expectations. In addition, you will encourage people to share their concerns. Communication and feedback will be open and honest. Fears will disappear. This positive response will be contagious and each person’s contribution to the organization will increase. In fact, if you have a non-performing, problem employee, they will feel peer pressure that will require a response. If they attempt to “poison the well” (create negative feelings between management and co-workers), they will fail.

More often than not, the problematic, non-compliant employee will change to meet the expectations of the organization or they will be compelled to leave. If this does not occur, you will need to cut the cord by replacing the individual. If you don’t, you will weaken your position as a leader and experience a deterioration in staff morale.


Lighten up! This begins with valuing every employee and being enthusiastic. The common denominators that exist with managers who love their work are basic. It is their respect for the company, their enthusiasm and confidence about what they are achieving and the pride they take in the accomplishments of the people they work with. If each of us appreciates and enjoys our staff, recognizing that their contribution is critical to our success, we will reap the rewards.

If you apply these simple principles, you will be amazed at the organizational accomplishments that can be achieved. A WISE decision is a matter of applying common sense principles that respect and value the contribution of each individual. You won’t need complicated, time-consuming monitoring tools. You will have open communication and feedback that keeps a pulse on your organization. Management and staff will develop a passion for their work – it’s contagious.

It may be difficult to change habits and establish new work patterns. An outside expert can be the perfect catalyst to get you headed in the right direction. WISE-Watch, Inspire, Support and Enjoy – It’s a personal investment in people that will bring you economic results and organizational success!

Rebecca Anwar, Ph.D., is a senior consultant with The Sage Group Inc., a national consulting firm specializing in strategic planning, integrated health care development, managed care training and marketing. She is a member of the National Association of Healthcare Consultants.

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