This is an exploratory case study evaluating the process of TQM implementation in the 23 TQM demonstration sites in the NHS. These sites were set up in 1989 by the Department of Health as centres of excellence for the implementation of TQM. An earlier study' evaluating TQM in the NHS failed to adequately contextualise the reasons for the argument that orthodox TQM has failed in the NHS. Against this background, it became necessary to carry out an extensive reassessment of TQM initiatives in the NHS. The central thrust of the study involves the identification of: i.the differing modes of implementation of TQM across the sites; ii.the difficulties managers were encountering in the implementation of TQM - barriers to the implementation of TQM; iii.the critical key success factors for the successful implementation of TQM in theNHS; and, iv.based on empirical evidence seeks to determine whether a specific model of TQM is required in the NHS. As Francis Bacon noted, 'if anyone wants to understand nature, he has to study nature rather than base their understanding on Aristotle's postulations of nature. This is because Aristotle did not understand nature, his ideas about nature were not empirically determined'2 Hence, to gain a conceptual understanding of TQM, it is necessary to understand 'implementation' and not base understanding on the outmoded ideas of the Gurus, whose philosophies are not grounded in empirical data. Thus, the TQM literature is inundated with TQM models that are based on anecdotal evidence and the personal prescriptions of TQM writers'. This situation has led to a call by a number of writers' for an empirically determined implementation model for TQM; particularly in the healthcare setting. To determine whether such a model is required in the NHS, this exploratory study used a unique combination of qualitative and quantitative data to sample 23 Quality Managers at the 23 TQM sites in order to provide an accurate rendition of the TQM process in the NHS. The study makes a valid contribution to the quality literature, by contending that TQM has not failed in the NHS as earlier suggested by one stud?, but is yet to be tried. Allegations of failure arise from improper implementation, which is itself symptomatic of the lack of a context-specific model for the implementation of TQM in the NHS. The conclusion was reached from a number of perspectives: (1) the critique of current TQM literature which is based on the personal ideas of quality management proponents (Chapter Three). (2) a reconceptualisation of the implementation of TQM. The study suggests that the traditional paradigms of TQM lack adequate contextualisation. They only provide answers for the "what" of TQM in the form of step-by-step approaches, or of TQM as a vehicle for culture change, without providing the practising manager with the 'how' of the implementation process. This apparent limitation, the author suggests, makes TQM orthodoxy inappropriate to deal with the complexities of the NHS (Chapter Four). (3) the study also found that the suggestions in the literature that the barriers to the implementation of TQM have generic applicability across organisations is a misnomer. In most of the hospitals the difficulties that quality managers were facing were specific to the organisational context (Chapter Five). (4) seventeen critical success factors were identified as valid and specific to the NHS. These factors, unlike the 'Ten Critical Success Factors' identified by Black6 are of equal importance for the implementation of TQM and are not categorised on a scale of importance (Chapter Seven). In the final analysis, the study, as a major contribution to knowledge in the quality management field, provides the first empirically determined context specific model for the implementation of TQM in the NHS. The model represents the first problem specific model validated by the experiences of fifteen quality managers in the NHS. It provides an empirical understanding of the 'nature' of the implementation of TQM within the confines of the British National Health Service. In addition, a measurement framework to monitor the progress of TQM at various stages of the implementation process is offered (Chapter Seven).

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Total Quality Management (TQM) and the issues relating to its implementation have been widely discussed and debated in the business and management literature during the last few years, particularly in the West. The implementation of TQM principles, concepts and methods in an organisation has been regarded as a real movement towards transforming its culture and improving its management processes and the quality of its services and products. Nevertheless, available data on TQM implementation within the context of the developing countries are limited or mainly focused on the manufacturing sector. Little research has been carried out on the subject within the service sector, particularly within the telecommunication sector. The issues relating to TQM implementation in this study are investigated within the context of a developing country; namely Oman; more particularly, within the context of the Omani telecommunication sector. Against this background, this study examines the feasibility of introducing TQM into Oman Telecommunications Company (OMANTEL). The study provides an analysis and assesses the extent to which there is a need for TQM implementation in OMANTEL, and the extent to which the company's internal environment is compatible with the tenets of TQM. The study is based on both secondary and primary data analysis. The secondary data are used to delineate the underpinning principles, methods, tools and techniques of TQM and to offer a background to the organisation under investigation. The secondary data were obtained through a survey of TQM literature and the archival data relating to OMANTEL. The primary data were obtained through an empirical study by questionnaire and conducting several interviews within OMANTEL. The primary data obtained are presented to manifest the extent to which it is feasible to introduce TQM in OMANTEL and to offer recommendations that would enhance this feasibility. The secondary data analysis reveals that there are several emerging trends in the Omani telecom sector that entail some changes in OMANTEL. The secondary data analysis reveals that TQM has much to offer to OMANTEL in order to meet those emerging trends. The primary data analysis reveals that there is a limited knowledge and understanding amongst OMANTEL's personnel of TQM and that there is a significant need for TQM implementation in OMANTEL. The primary data analysis reveals that there are some barriers that could be encountered in implementing TQM in OMANTEL; nevertheless, there are some driving forces that could facilitate this implementation. The primary data also reveals that the internal environment of OMANTEL is conductive to implementing the elements, concepts and principles of the proposed TQM framework.

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Notre thèse repose sur le constat, confirmé par les auteurs et les professionnels, que le management par la qualité totale (TQM) est un mode de gestion centré sur la qualité, visant la rentabilité à long terme par la satisfaction des clients et l'amélioration continue de l'ensemble des processus de production. Notre travail a pour objectif d’explorer les déterminants qui assurent la pérennité de la réussite de ce système managérial. En adoptant un mode exploratoire de recherche basé sur une étude clinique, nous avons choisi le groupe CODIM comme un terrain pour effectuer notre étude de cas. Dans cette perspective, notre question de recherche est formulée de la manière suivante :- Quels sont les déterminants de la réussite pérenne du management par la qualité totale ?Nous avons entrepris de répondre à cette interrogation lors d’une recherche en trois phases :• Une phase de conceptualisation qui comprenait une étude approfondie du concept du management par la qualité totale, fondée sur l’expérience des auteurs et sur la littérature existante, ainsi que l’étude des théories et des pratiques liées au TQM.• La seconde phase visait à élaborer un modèle idéal des déterminants de réussite du management par la qualité totale, concrétisé par l'ensemble des variables explicatives de notre question centrale.• La troisième phase consistait à expérimenter notre modèle théorique et à tester nos hypothèses grâce à une étude qualitative suivie d'une étude quantitative. / Our thesis is based on the fact, confirmed by the authors and professionals that the total quality management (TQM) is a management focused on quality, for the long-term profitability by customer satisfaction and improving all continuous production process. Our work aims to explore the determinants that ensure the sustainability of the success of the managerial system. By adopting an exploratory search mode based on a clinical study, we chose the CODIM group as a ground for making our case study. In this context, our research question is formulated as follows :- What are the determinants of long-term success of the total quality management ?We set out to answer this question during a search of three phases:• A conceptualization phase that included a thorough study of the concept of total quality management , based on the authors experience and the literature, and the study of theories and practices related to TQM .• The second phase was to develop an ideal model of the determinants of success in total quality management, embodied by the set of explanatory variables in our central issue.• The third phase was to test our theoretical model and test our hypotheses through a qualitative study followed by a quantitative study.

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