ABSTRACT
The main counter-argument is that in the NHS, as in the public and private sectors in most developed countries, a quality 'industry' has developed which focuses more or less exclusively on the quality of every aspect of a Trust's behaviour and outputs. Total Quality Management (TQM) is an approach to quality which is at best a way of life and at worst a meaningless buzzword. TQM is a cost-effective approach, involving everyone in the organization, continually to improve the quality of service provided in order to satisfy the customer. A more tightly focused view of quality is that which doctors mean when they include quality standards in contracts and service agreements. Several approaches have been developed, all of which bring insights into what we mean by quality in service delivery and how it can be achieved. In the NHS, Sir Robert Maxwell, Secretary of the King's Fund Foundation, suggested some specific dimensions of health care quality.
