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Describes the experiences of several public hospitals which have implemented quality methods and management and lists some of the lessons they learned that could be usefully adopted by other services. Asks: how do you introduce a quality programme into an organization whose employees are already empowered, and who view themselves as the sole arbiters of quality? Is a quality programme doomed if the preconditions proposed by the “quality gurus” are absent ‐ such as top management commitment and constancy of purpose? Which type of quality programme is feasible when there is no time and money for quality investment, and customer satisfaction is only one of the many determinants of organizational survival in a political environment? Concludes that generally, the hospitals which had a greater success found ways to involve different professions and adapted the methods to their particular circumstances.

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