Application of TQM to mental health: Lessons from ten mental health centers

Background: The principles and techniques of total quality management (TQM) have only recently been applied to the field of mental health. This article reviews issues and offers some preliminary observations, based on the author's consultation and training work with ten state-operated mental health organizations in Missouri (Jul 1, 1994-Jun 30, 1995). Cultural dimension: Since many mental health organizations have operated in the public sector as part of large, hierarchical state agencies, the legacy of bureaucratic structures and a command and control leadership style may pose additional challenges. Technical dimension: Two types of training have proven helpful in the Missouri project: general overview or awareness training for all staff and specialized training for team leaders and facilitators. Strategic dimension: To be successful with TQM, mental health organizations should clearly delineate their governing ideas, continuously reinforce them with all staff, and use the ideas as a measuring stick for progress. Some of the organizations in the Missouri project link their governing ideas and strategic planning efforts with critical success factors and the measurement methodology to track them. Structural dimension: This dimension, which may include a quality council, a quality department, and quality improvement (QI) teams, also extends to the way in which facilities are organized and function. The structure evolving from a team-oriented, time-limited, data-based, and problem-solving approach can facilitate the functioning of the entire organization. Conclusions: The philosophy and techniques of TQM are as applicable to mental health as to health care in general-the question is one more of motivation than of fit.