title: Determinants of quality management systems implementation in hospitals.
abstract: OBJECTIVE
  To identify the problems and facilitating factors in the implementation of quality management system (QMS) in hospitals through a systematic review.
  
  
  METHODS
  A search strategy was performed on the Medline database for articles written in English published between 1992 and early 2006. Using the thesaurus terms 'Total Quality Management' and 'Quality Assurance Health Care', combined with the term 'hospital' and 'implement*', we identified 533 publications. The screening process was based on empirical articles describing organization-wide QMS implementation. Fourteen empirical articles fulfilled the inclusion criteria and were reviewed in this paper.
  
  
  RESULTS
  An organization culture emphasizing standards and values associated with affiliation, teamwork and innovation, assumption of change and risk taking, play as the key success factor in QMS implementation. This culture needs to be supported by sufficient technical competence to apply a scientific problem-solving approach. A clear distribution of QMS function within the organizational structure is more important than establishing a formal quality structure. In addition to management leadership, physician involvement also plays an important role in implementing QMS.
  
  
  CONCLUSIONS
  Six supporting and limiting factors determining QMS implementation are identified in this review. These are the organization culture, design, leadership for quality, physician involvement, quality structure and technical competence.
authors.affiliation: Department of Public Health, Faculty of Medicine, University of Brawijaya, Malang, Indonesia.
authors.forename: Viera
authors.initials: V
authors.lastname: Wardhani
authors.forename: Adi
authors.initials: A
authors.lastname: Utarini
authors.forename: Jitse Pieter
authors.initials: JP
authors.lastname: van Dijk
authors.forename: Doeke
authors.initials: D
authors.lastname: Post
authors.forename: Johan Willem
authors.initials: JW
authors.lastname: Groothoff