Total Quality Management in Healthcare: Quality Principles, Implementation and Digitalization

Purpose: This paper reviews and synthesizes the theoretical foundations and practical applications of Total Quality Management (TQM), highlighting current trends, organizational prerequisites, benefits, and common barriers, with emphasis on operationalizing core TQM principles and adapting them to healthcare settings. The quality of healthcare is increasingly recognized as a strategic priority due to its impact on treatment outcomes, system efficiency, and user experience. Within this context, TQM is affirmed as a comprehensive, sustainable model for systematic quality improvement. Design/Methodology: A narrative literature review with thematic analysis of recent literature was conducted using Web of Science, Scopus, PubMed and Google Scholar. Findings: TQM principles are associated with improvements in safety, efficiency, patient experience, and resource use. Lean, Six Sigma, and Lean Six Sigma report measurable gains, including shorter waiting times, fewer errors, and cost reductions. Successful implementation depends on leadership commitment, open communication, a participatory culture, and staff capability, while common barriers include bureaucratization, fragmentation, limited empowerment and training, and poorly defined processes. Quality 4.0 and Healthcare 4.0 expand opportunities for predictive, data-driven, and personalized quality management. Practical Implications: Organizations should operationalize TQM with clear accountability, leadership commitment, and a participatory quality culture, leveraging Lean/Six Sigma for measurable improvements while aligning digital initiatives (Quality 4.0/Healthcare 4.0) with core TQM principles and building skills and infrastructure. Originality/Value: The paper connects TQM with current healthcare challenges and digital transformation, highlighting how organizational and technological factors jointly shape quality outcomes and system-level improvement.