Obstacles to TQM success in health care systems

Int J Health Care Qual Assur. 2013;26(2):147-73. doi: 10.1108/09526861311297352.


Purpose: Many healthcare organisations have found it difficult to implement total quality management (TQM) successfully. The aim of this paper is to explore the barriers to TQM successful implementation in the healthcare sector.

Design/methodology/approach: This paper reports a literature review exploring the major reasons for the failure of TQM programmes in healthcare organisations.

Findings: TQM implementation and its impact depend heavily on the ability of managers to adopt and adapt its values and concepts in professional healthcare organisations. Unsuccessful TQM efforts in healthcare organisations can be attributed to the strongly departmentalised, bureaucratic and hierarchical structure, professional autonomy, tensions between managers and professionals and the difficulties involved in evaluating healthcare processes and outcomes. Other obstacles to TQM success include lack of consistent managers' and employees' commitment to and involvement in TQM implementation, poor leadership and management, lack of a quality-oriented culture, insufficient training, and inadequate resources. The review was limited to empirical articles written in the English language during the past 30 years (1980-2010).

Practical implications: The findings of this article provide policy makers and managers with a practical understanding of the factors that are likely to obstruct TQM implementation in the healthcare sector.

Originality/value: Understanding the factors that obstruct TQM implementation would enable managers to develop more effective strategies for implementing TQM successfully in healthcare organisations.

Publication types

  • Review

MeSH terms

  • Health Services Administration*
  • Humans
  • Inservice Training
  • Leadership
  • Organizational Culture
  • Total Quality Management / organization & administration*