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As healthcare providers have embraced Total Quality Management (TQM) or Continuous Quality Improvement (CQI), as it is known in numerous healthcare organizations!, much emphasis has been placed on education and training in the use of TQM and CQI tools: statistical quality control methods and techniques, employee empowerment, and other outcome-oriented methods of the quality movement. While these tools are important to achieving total quality, singular emphasis on the tools of TQM places the cart before the horse.
The impetus for quality improvement begins with the customer. Customers are drawn to products and services of a particular provider because they feel their needs and expectations are met or exceeded by these products and services--not because the provider has better TQM training programs, uses statistical quality control, or has a certain corporate culture. The bottom line for the customer has always been whether he or she obtains the products and services desired. For this reason, a focus on customer needs and expectations is recognized as the key to quality improvement by Demming, Juran, Crosby, and other pioneers of TQM.
Identifying customers is more challenging for healthcare organizations than for many other service organizations due to the unique nature of the healthcare environment. Typically, an organization's customers can be fairly easily identified: the customer is the party for whom the service is rendered and from whom revenue is collected. In health care, services are rendered to patients, and revenue is collected from insurance companies, government...