TY - JOUR T1 - Total quality madness? JF - British Journal of General Practice JO - Br J Gen Pract SP - 892 LP - 893 VL - 55 IS - 520 AU - John Middleton Y1 - 2005/11/01 UR - http://bjgp.org/content/55/520/892.abstract N2 - In 1993 I attended a seminar on education and training in the management of quality, sponsored by the Department of Trade and Industry. The message was clear: people bought Japanese products because of their quality and reliability. Now we had to learn from their methods to make British industry more competitive and to ‘take the heads off the opposition’. We would make more profit and everyone would be happy: the customers, the bosses and the workforce (who would deserve a rise). I was there to see how the principles of Total Quality Management (TQM) might apply in the health service, particularly in the field of education.TQM sounds like heaven on earth. First you make contact with the customers and find out what they really want. Then you work out how to supply it cost-effectively. The workers need to understand their role in this process and you need to listen to their problems in delivering it. Listen and support them in solving the problems. Aim for doing the right things first time. Establish trust and get commitment. Trust them to do a good job and check only a sample of the output. Make use of continuous feedback from customers and workers to refine the process. The customer is delighted. Everyone gets a rise.Only kidding. The competition just became hotter. Everybody's doing it — TQM that is, and now we even have Japanese car factories in the UK. At least the customers should be pleased. Patients should be pleased, too, because a version of TQM has become embedded in the health service — it's called clinical governance.At first sight the two systems are very similar. Patients' … ER -