The implementation of total quality management within purchasing District Health Authorities of the NHS.

At its most basic, Total Quality Management (TQM) is about improving quality across the whole of an organisation by meeting customer requirements. The benefits claimed to be enjoyed by organisations which have implemented TQM include substantial reductions in costs and increased efficiency and customer satisfaction.This research considered TQM within the context of the programme of National Health Service (NHS) reforms, introduced by the Government, and intended to reduce operating costs and improve the quality of care. The creation of the NHS internal market in 1991 required Purchasers and Providers of health care to enter into a contractual arrangement between themselves, in which price, volume and quality of service delivery were to be stipulated.Against this background, the research has analysed attempts to implement TQM within District Heath Authorities (DHAs) since assuming the role of Purchasers of health care in the internal market. It has examined the extent of TQM awareness and understanding within DHAs and assessed the prospects for its successful implementation.The research was based on data secured through interviews with DHA Service Quality Managers and a postal questionnaire distributed to all DHAs in England.The results revealed that while quality remained an official priority for NHS managers, TQM had not been widely adopted by DHAs and that there was an overall lack of awareness and understanding of TQM principles. Difficulties associated with implementation including a lack of expertise, a lack of resources, a high incidence of organisational change, the lack of senior management commitment, and an overall willingness to allow quality to be afforded a lower priority than other issues.Although previous research has been carried out concerning the implementation of TQM within the NHS, it has exclusively focused on the activities of Providers. This is the first piece of research to have focused on the implementation of TQM from the perspective of the Purchaser and, therefore, has developed both an understanding of TQM within a functionwhich is distanced from the customer interface, and has provided a more accurate picture of the state of TQM within the NHS as a whole.