title: Implementing TQM in the health care service.
abstract: OBJECTIVE
  The present study seeks to present a case study over four years following an implementation process of total quality management (TQM) on an ICU (intensive care unit).
  
  
  METHODS
  The aim was to describe consequences shown in the organisational climate, workload and staff wellbeing. A case study design was employed using a longitudinal method of data collection.
  
  
  RESULTS
  Downsizing due to diminishing resources was a parallel process probably disturbing the TQM implementation. The workload increased by 20 per cent, whereas organisational and individual variables remained stable over time. However, sick leave increased dramatically and was higher than the general level within the Swedish population. The ICU had the capacity to adapt successfully by regulating working hours to workload. It is speculated that another cause behind sickness absence exists other than the general opinion. The literature used for the discussion departs from the relation between people's understanding and acting, sensemaking, and organisational theories describing complex adaptive systems emphasizing attraction patterns. Organisational ambiguity was a main finding in an earlier study that was used for interpretation of the result in the present study. As ambiguity seems to be a major and increasing problem, it has consequences for management as well as for continuous quality development.
  
  
  CONCLUSIONS
  The implication of the study is the need to be able to successfully work in an ambiguous situation and use the quality system as a device in day-to-day work.
authors.affiliation: Center for Clinical Research, University of Uppsala-Gävleborg, and Department of Public Health and Caring Sciences, Health Service Research, University of Uppsala, Uppsala, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Lindberg
authors.forename: Urban
authors.initials: U
authors.lastname: Rosenqvist
mesh_terms: D000328:Adult; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D007588:Job Satisfaction; D008137:Longitudinal Studies; D008875:Middle Aged; D019982:Organizational Case Studies; D015279:Organizational Culture; D018582:Sick Leave; D013222:State Medicine; D011795:Surveys and Questionnaires; D013548:Sweden; D017749:Total Quality Management / Q000458:organization & administration*