Total Quality Management: The Health Care Pioneers.

This new book is an impressive work by two individuals highly credentialed in the area of total quality management (TQM). It is a very appropriate volume for the library of any physician manager interested in either basic or advanced quality improvement strategies. The focus of the book is basically practical, but it is theoretical enough to appeal to researchers and teachers in the field. Additionally, it is replete with examples and, consistent with TQM, charts and statistical information that will be helpful to any practitioner of either management or quality improvement.

The book's introduction includes a foreword and a preface that set expectations for the reader in a clear and appropriate fashion. As stated in the preface, the purpose of the book is "to share the lessons learned by pioneers in health care about how to harness the full power of total quality management. In this task, I believe the book succeeds admirably.

Part 1 of the book, entitled "Lessons from Health Care TQM Pioneers: The Key Success Factors," is a concise and well-written description of the basic philosophy of TQM from a variety of perspectives. The book does not assume that any of the current "gurus" has the "ultimate answer" for any given facility or institution, but it does summarize each approach, as well as provide some unique approaches synthesized by the authors and their resources. Chapters on visionary leadership, commitment to customers, trained teams, physician involvement, the total quality management process, and alignment of management systems are all extremely lucid and well supported with helpful references and the aforementioned statistics and graphic representations. The chapter on physician involvement is particularly strong relative to the physician manager and provides a clear differentiation between TQM and traditional quality assurance that many physicians will find helpful in educating their medical staffs and other personnel.

The only weakness in this section is that all the examples, and there are many, are written from the perspective of an institution, i.e., a hospital, a group model HMO, and the like. For those involved in more non-traditional health care settings, such as PPOs and IPAs, the examples are only theoretically helpful. This weakness is particularly notable in light of the obvious strengths of the material. It also may highlight one of the problems with TQM, in that it is really an outgrowth of the corporate structure and has had to be adapted to medical management systems. It has long been problematic for those in less traditional environments as to how quality assessment activities can best be applied and monitored. This book, while helpful philosophically, unfortunately does not contribute to that practical need.

Part 2 begins with a description of the Malcolm Baldrige National Quality Award criteria and progresses through a discussion of the Joint Commission on Accreditation of Healthcare Organization's approach to TQM in a variety of more philosophical pieces on the future of TQM. A strength of this section is in its elucidation of quality improvement as a evolutionary process by its very nature, noting that TQM must also evolve as systems and the demands of our environment change. Once again, a particularly helpful chapter is the one on physician involvement. This chapter should be required reading for those involved in managing physicians, because it highlights the fact that physicians must become part of the team as opposed to autocratic leaders of teams.

In summary, this book is a strong addition to the TQM library and would be a very helpful resource for all in physician and clinical management. Its few weaknesses do not significantly detract from its overall value.--Scott P. Smith, MD, MPH, FACP, National Medical Director, Healthcare COMPARE Corp., Downers Grove, Ill.