Improvement is based on both outcome and process.
Total Quality Management places primary emphasis for problem characterization on the system rather than the individual. The customer in TQM is not only the patient but also the many users of a department's output. These managers knew there was a problem, but because they were not asked to solve the problem, they felt responsible only for their own functions, not a system, therefore the problem continued. All healthcare providers will be held more accountable for their actions and need to be able to demonstrate quality and efficiency of care. It is important to note that quality of care is considered the number one priority.