Background/Aims Implementation of total quality management in healthcare services has often been unsuccessful. This is a result of a variety of factors, including the inadequacy of learning and knowledge sharing methods to support implementation. This study aimed to explore how learning and knowledge sharing policies influence total quality management initiatives in the healthcare sector. Methods An extended total quality management model, named the ethical, adaptive, learning, and improvement model, was developed and implemented in a private healthcare organisation in the UK. Using action research, data were collected from 91 participants over a 21-month period from qualitative interviews, focus groups and participant observations. Results Practice-based training was found to increase employee competence, reflecting the importance of tacit knowledge sharing. The model led to the prevalent blame culture changing to a learning culture through an appreciative management style that focused on recognising what is done right. In addition, patients' satisfaction and quality of care improved through community groups that were set up to address quality problems and patients' needs. Conclusions Adequate knowledge sharing methods play an important role in improving quality in healthcare. Greater consideration should be given to this widely ignored aspect when implementing total quality management in NHS trusts.

Adopting TCG could enable healthcare managers to ameliorate their services with little or no extra cost, which is especially important in a budget constraint context and the current quality crisis facing UK healthcare.

UK healthcare has been facing an unprecedented quality crisis in recent times. In this context, the author setout to develop and evaluate the use of a novel total quality management (TQM) model in a private healthcare firm with the aim of improving patient care. By integrating contemporary organizational theories with TQM, an innovative model called EALIM-ethical, adaptive, learning and improvement model-was devised. Using an action research study, qualitative data were gathered in three research cycles, (1) preimplementation, (2) implementation, and (3) post-implementation. Initial results showed EALIM's adoption generated a moral organizational perception among employees, increased organizational commitment, emergence of a learning culture, and improvements in patient self-advocacy and independence. However, other findings indicated poor leadership produced variability in service quality. Although outcomes from this study clearly indicated that EALIM generated organizational improvement, commitment from all internal stakeholders is required to achieve sustainable quality patient care.

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