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Examines the developing importance of the quality issue in the service sector and highlights common barriers to the successful implementation of total quality management principles (TQM). Such information provides managers in complex service organizations such as the National Health Service (NHS) with valuable lessons for improving quality standards. Illustrates how TQM principles could and in a few cases are already being applied to the NHS in the light of the 1989 Government proposals for reform. Such efforts are in the early stages of development and therefore guidelines are proposed to assist management in sensitive areas for implementing change.

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