The findings of this literature review are presented in three major discussions. Literature related to the quality improvement concept is reviewed first, while literature related to the principles of reorganization and reconstruction within a quality improvement environment is reviewed second. Literature related to the interrelationships between quality improvement programs and reorganization and restructuring in hospital settings is reviewed in the third discussion.
Quality improvement is sought in contemporary organizations through the implementation of strategies based on concepts with names such as TQM (total quality management), CQI (continuous quality improvement), and others. These various concepts are highly interrelated, and quality improvement in most organizations is dependent upon strategies that embrace a combination of two or more of these quality improvement concepts (Marszalek-Gaucher & Coffee, 1991, pp. 83-147). A. V. Feigenbaum (1991, pp. 5-6) developed the concept of total quality control (TQC) that underlies many quality management concepts. Karou Ishikawa (1985, pp. 1-13; 1982, p. 99). contributed the concept of quality circles. James Harrington advocates the pursuit of quality through business processes as opposed to production processes. For health care delivery institutions, the most useful conceptual combination involves TQM and CQI (Melum & Sinioris, 1992, pp. 159-224).
The successful implementation of a TQM program requires the involvement of every facet of an organization's operation and every organizational member in the effort to promote high product quality (Atkinson, 1990, p. 5). TQM, therefore, tends to produce incremental quality gains, as opposed to dramatic, one-shot improvements (Creech, 1994, pp. 243-293).
TQM is a logical outgrowth of the quality control strategy promoted for years by the late Edwards Deming (Neave, 1990, p. 26). Deming's (1986, pp. 18-96) quality control strat...