Total quality management is, in part, a philosophy saying that achieving excellence involves a constant forward effort from all of an organization's employees. TQM works by measurement: finding the right criteria to assess and track quality levels. In healthcare settings, excellence is measured in health outcomes and patient satisfaction. Even in small businesses, such as physician practices and home health care providers, these factors can be tracked and turned into a competitive advantage.

Total Quality Management (TQM) may have been the first quality-oriented philosophy to transition into healthcare.   TQM is based on three principles: continuous quality improvement (CQI), customer focus, and teamwork.  To date, limited research attention has been given to the challenges involved in adopting such practices in healthcare.  Despite the enthusiasm raised by the potential benefits, many initiatives have not fully delivered the promised results.  Some of the reasons for failure can be traced to the insufficient support of health professionals, the lack of leadership commitment, and the tendency to look at TQM in isolation rather than putting it at the core of the institution’s strategy.