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, customer focus, and teamwork.

To date, limited research attention has been given to challenges involved in adopting such practices to 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 core of the institution’s strategy. Moreover, there exist various powerful subcultures (e.g. manager’s subc