title: Implementing TQM in a military hospital in Saudi Arabia.
abstract: BACKGROUND
  Health care services in the Kingdom of Saudi Arabia are unique not only in the varied patient population served and multinational staff recruited to provide services, but also because they are not driven by financial or medicolegal constraints. As part of a five-year plan (carried out in four phases) to improve the quality of health care provided in the Kingdom, the North West Armed Forces Hospitals (NWAFH) in Tabuk became the first health care facility in the Kingdom to implement total quality management (TQM). This was not an implementation de novo, but a well-coordinated transition from quality assurance (QA) to TQM. The hospital leadership believe that TQM is best implemented when there is a strong foundation of QA to provide a pre-existing process for data collection and performance measurement.
  
  
  METHODS
  Using the eight-step model for implementing TQM adapted from Joint Commission standards and The Health Care Manager's Guide to Continuous Quality Improvement, the QA staff identified the customers of the QA department, their needs, and professional requirements; implemented changes to meet these needs; identified internal monitors to evaluate the effectiveness of the operational changes and monitor performance; reported results and identified opportunities for improvement; and problem solved with FOCUS-PDCA.
  
  
  RESULTS
  These efforts yielded a customer satisfaction survey in the form of a report card. In addition, three case studies launched by the QA department to address abstract data accuracy and completion, nosocomial infection rates in cesarean-section patients, and receipt of hospital laboratory reports by peripheral clinics are described in detail.
  
  
  CONCLUSIONS
  The NWAFH Program leadership believes that TQM is a pancultural concept and that these first successful efforts can provide a model for the expansion of TQM not only in Saudi Arabia but throughout the rest of the Middle East.
authors.affiliation: Student Health Center, New Mexico State University, Las Cruces 88003.
authors.forename: E J
authors.initials: EJ
authors.lastname: Hoskins
authors.forename: F
authors.initials: F
authors.lastname: Abdul al-Hamid Noor
authors.forename: S H
authors.initials: SH
authors.lastname: Ghasib
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D003431:Cross-Cultural Comparison; D005260:Female; D006772:Hospitals, Military / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D007755:Laboratories, Hospital; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011247:Pregnancy; D016730:Program Development; D012529:Saudi Arabia / Q000453:epidemiology; D017749:Total Quality Management / Q000458:organization & administration*