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Explores the Total Quality programme adopted by the National Health Service, highlighting the issues which make sustaining the commitment of all staff to quality improvement processes possible. Discusses the tension created by linking quality improvement to reducing quality costs of health care. Outlines the timetabling of strategy development and implementation, and the management of he timetabled process. Reviews key milestones in staff awareness, looking at co‐ordination and management of quality improvement activities; understanding of the design/conformance/corrective action cycle; understanding of the relationship between quality improvement and costs; and sustaining involvement of staff. Suggests that despite concerns from clinicians and managers alike, regarding the pressures involved with implementing TQM, a successful team should improve service to the patient.

As the pressure and concern for quality throughout all hospitals and community services develops, provider units are beginning to appreciate the relevance of management and organisational approaches to achieving Total Quality Service. A brief overview of Total Quality Management in health care is given and the difficulties experienced in introducing such a system are outlined.

Senior managers from several of Hong Kong′s 36 hospitals gave their views, during a management development programme, as to what issues were relevant to the ongoing quality of hospital care in Hong Kong. Results indicated different priorities for five main areas: corporate culture, staff involvement, staff recognition, quality systems and consumerism.

Outlines team development at the Aylesbury Vale Community Health Care NHS Trust, highlighting structure, culture and techniques of QITs, and the bias for action. Suggests that the key to empowerment is showing staff that they have gained the skill, confidence and support from senior management to innovate and change/improve the service.

Achieving the best health care delivery involves a tension between quality and quantity of health care and its cost. Usually the latter ‐ the cost ‐ is debated in terms of its insufficiency. In addition, however, the amount of revenue tied up in “failure costs” or the cost of poor quality can, in any hospital or community service, be appreciable. A model of quality costing to address these issues is outlined.

This article is a report of a symposium on quality assurance in mental health services which took place on 10 March 1989 at Tone Vale Hospital, Taunton.

Outlines four interconnecting factors which are essential to motivating staff: an understanding of the “psychology of excellence in teams”; establishing cross‐functional quality improvement teams; understanding and reviewing processes of care and service; and the use of data display.

A second article describing the significant move of United Christian Hospital towards “continuous quality improvement”. Describes the general surgery CQI programme, its problems and successes.

Outlines and discusses the implementation plan and associated training programme for establishing TQM in one of the hospitals in Hong Kong. Gives examples of the training programme and outlines quality management plans.

Outlines the introduction of total quality systems into all clinical services within a community‐based NHS Trust in the West Midlands. Provides practical details of each aspect of the quality‐planning process. Shows the commitment of clinicians to “managing quality improvement”.