Demands for quality treatment and lower costs of the treatments are increasing constantly, so the competition amongst hospitals is growing, and the hospitals with better care, higher level of professionalism and lower costs are preferred amongst the patients. Hospitals are facing with customer dissatisfaction with services almost on a daily basis, with escalating costs, intense competition, and as a result, many hospitals have incorporated total quality management (TQM) to improve quality care and decrease costs. Costs might be contained with a better quality service. Although quality has a cost, the failure to provide quality can provoke higher rates of costs because, if a product or service does not satisfy a customer, the cost of putting the situation right after failure may be greater than actually preventing the failure from the outset (Jarlier, A., Charvet-Protat, S. 2000, p. 125). Preventing the failure should be regarded as one of the most important strategies for reducing costs.
This approach is known as total quality management (TQM), or continuous quality improvement (CQI), and there is a hope that widespread implementation of the underlying philosophy, approaches, and tools of CQI/TQM will result in an ability of an organization to both maintain and improve quality while controlling increases in costs. The key elements, the key factors in a combined definition of CQI/TQM include continuous, long-lasting improvement, customer focus, structured processes, and organization-wide participation. This approach, the CQI/TQM approach differs from the traditional quality assurance in many ways. Among the most important difference comes from CQI/TQM's focus on understanding and improving underlying work processes and systems versus the traditional quality assurance emphasis on correcting after-the-fact errors of individuals (Shortell S et al. 1995, p. 378). Total quality management (TQM) also can be defined as a structured process for creating organisation-wide participation in planning and implementing continuous improvement in organizational culture (Weiner, B. et al. 1997, p. 493).
Implementation of total quality management (TQM) in health care delivery systems has been well accepted in many countries and it has shown the continuous improvement in different areas of the health care delivery system and the potential of controlling the rise of health care costs (Coruh, M. 1996, p. 83). For the past decades, the concept of 'quality of care' has served as a unifying notion in helping us to identify and monitor the structure, process, and outcome of health care delivery (Plochg T. & Klazinga N. S. 2002, p. 98). TQM attempts to bring about continuous improvement in quality of care and prevent a failure through a system of communication, training and organization processes. The areas that need to be worked on are redefined so that there is room for change and re-organisation (Jarlier, A., Charvet-Protat, S. 2000, p.126). The TQM philosophy and the TQM process