The Textbook of Total Quality in Healthcare

The Textbook of Total Quality in Health Care attempts to summarize in an introductory didactic format the state of the "total quality" (TQ) movement in today's health care industry. The target audience is "TQ and health care professionals and students in management, clinical, and support services." Although the editors present their work as a "textbook," it is actually a reader, comprising articles--some original and some published previously -- on the various dimensions of the TQ movement in health care and written by clinicians, academicians, health care administrators, and health law experts, mostly from the Oklahoma area. The result is a collection of articles characterized by the pluses and minuses typical of such synthetic attempts: the inclusion of number of different perspectives (even if somewhat localized) and an interesting combination of different types of articles. The perspectives of organized medicine and health care accrediting agencies proffered in this book are a welcome addition. The editors have done satisfactory job of bridging the sections with introductory transitional pieces. However, the book reflects the challenge involved in compiling a cohesive, well-integrated set of articles and presenting them in a "seamless" format. The book also suffers from some of the repetition that results when several authors are writing on the same subject. For example, W. Edwards Deming, probably the best-known TQM guru, is discussed in no less than eight articles. The book is divided into five parts and contains an annotated bibliography. The articles in Part I provide a useful introduction, to the concept of total quality, especially as it relates to health care. The short, but surprisingly enlightening history of U.S. health care and its obsession with "quality" is worthwhile. In Part II, the concepts of "structure", "process" and "outcome" as they relate to total quality are introduced, and the importance of these concepts is constantly reconfirmed throughout the work. Part II also introduces the reader to the leading thinkers in the history of total quality--an important section for TQM neophytes. Perhaps the most useful section of Part II is the distinction that is made between traditional quality assurance (QA) activities in health care and the more contemporary concept of TQ and TQM. While this section clarifies what TQ is, the reader has to wait until a later section to find out how TQ is distinguished from some of the other "quality" disciplines. The efforts to translate experiences with TQ in other industries to health care are not very convincing, given the unique character of the health care field. Some of the earlier experiments with TQ in health care are described, however, and these are helpful. The importance of process in health care is clearly brought home here. Chapter 5 in this section is devoted to data management for TQ. The material, however, does not appear to be specific to