Tasks of Total Quality Management (TQM)                                                                                    

avoid inflexibility
Traditional Quality Assurance can lead to inflexibility towards a changing situation hindering necessary change. Moreover, if TQM is applied superficially it only might cement inefficient procedures with time consuming testing procedures.

excess automatisation
Quality assurance realised through excess automatisation lowering flexibil response and necessary identification of the personal will lead to lacking motivation and do anything but TQM. Abusing automatisation in the beginning of change might only 'cement' inefficient structures.

3.2.2.2 Obstacles
What you need to overcome!
confrontation with change
Implementing TQM to raise quality and lower costs, calls for a radical change in the organisation of medical care and of daily unquestioned procedures. The biggest challenge will be to convince all the staff to question and adjust their routines. Changing their daily targets to totally different targets will induce a lot of friction. Imagine Moslems to eat meat from one day to the other. Accepted norms of good and bad which are never questioned will have to be changed. The confrontations towards necessary change can be put into classes.

1. A staff member who will lose formal power
2. A staff member who does not understand the overall need for change
3. A staff member who sees the overall need, but does not realise its daily consequences
4. A staff member who has difficulties in forgetting former procedures

The first two groups are rather specific but the latter more or less cover every staff member. It can be said that older staff and more specialist staff, practising only afew procedures, tend to have more problems confronting change than younger or less specialised staff. Of course, procedures one has done for years are hard to forget, even more so if this means giving up one's own experience and giving the competitive advantage to others.

status of physicians
Physicians generally assume a high social position, as they are saving lives and our health. However, in some countries this position is boosted through government official privilege and missing financial dependence from their patients. It is not to be questioned that physicians possess a status of special dignity. However, this status may not lead to taboo criticism and practically forbid needed feedback structures for the continuous improvement process. Formal positions may not allow a physician to do what they do best, due to the system's inflexibility. Introducing TQM in medical care will question the typical hierarchical structures of physicians in clinics. Physicians of all positions will be confronted with internal feedback channels and with outside feedback from their patients.

thinking functionally
Taylorism has strongly influenced organisation in medical care. Structuring tasks with identical functions together makes sense as specialisation leads to higher efficiency. However, following this principle without questioning can lead to a very splitted process regarding the patient. Patients' time is then taken for granted. Today's information technology even more reduced the need for splitting patients journey into many stations. It is then still possible that patients only do their fully individual clinic journey without producing disorder or logistic problems. Taylor's principle of putting tasks with the same function into the same organisational division still makes sense if applied in second priority, patients interest must come first.