In the next generation of management thinking, we must go beyond TQM and on to Deming's theory of profound knowledge, much of which is embodied in the field of organizational learning and in particular, in Senge's ‘Fifth Discipline’ or systems thinking. In this framework there is no explicit mention of quality but the goal is still a process of ongoing improvement, that is, quality is implicitly treated.Hospitals are thought to be pretty complex organizations to implement Senge's theory because they are hierarchical, skills intensive and most health care workers deal with their emotions, patient's emotions, doctor's emotions and fellow employee's emotions in highly intense situations. However, Senge's five ‘component technologies’ provide an excellent framework to begin with. Copyright © 2003 John Wiley & Sons, Ltd.