a comparative study of models and approaches to quality management in health systems

background : quality management is one of the most effective strategies for improving health system performance in developed and developing countries. this research was a comparative study on quality management models in health system of several countries. the main goal of this study was to identify the most significant dimensions of quality management and propose appropriate model for health system. methods : in this research asian, african, european, north and south american countries that have backgrounds in implementation of total quality models in health sector, were elected via a convenient sampling. in addition this study included world health organization and world bank experiences concerning quality in several countries. results : showed that in 22 studies in developing countries, outcome criteria do not exist, 7 studies utilized structural indicators and 3 studies utilized both process and structural indicators for assessing the quality of healthcare, also main goals of quality improvement in these countries were: increasing service efficiency, improving quality of services, improving quality of work life, cost decreasing, waste eliminations, appropriate usage of resource and developing organizational culture. conclusions : general approaches to quality in these countries were: quality assurance, iso 9002, cultural development, total quality management, process documentations and quality improvement projects. the most significant problems in implementation of quality management were: orgal1lzational resistance to change, lack of senior management commitment. lack of comprehensive planning, shortage of necessary resources, lack of employee participation and lack of health information systems. quality management model must emphasize cultural development strategies, employees' participation, strategic viewpoint, strategic planning and common viewpoint. the appropriate model for this purpose is strategic total quality management (stqm).