Quality management in general surgery: a review of the literature

Introduction: Total quality management is a systematic approach focused on satisfying customers' expectations, identifying problems, analytically solving patient's problems and to implement continuous quality improvement. Method: Systematic review of the English language medical literature, using electronic search of the Pubmed, ProQuest and ScienceDirect databases with different combinations of the keywords: total quality management, healthcare, trauma, and minimally invasive surgery. Results: The assessment of outcomes in surgery represents a part of the quality assurance of patients' care. Usually, the surgeons have their own set of mental variables that can predict good and bad outcomes Surveys of complication rates and outcome are a poor substitute for quality control. For the reported complications it is impossible to know which complications are real (inherent to surgery and unavoidable) and which are a consequence of a mistake or an error in judgment. For polytrauma patients, optimal outcome requires an initial management fulfilling a high standard of quality assurance. A prerequisite is the availability of adequate resources at all times, including personnel, technical equipment, and special designed emergency room. Conclusions: Romanian hospitals need a more aggressive implementation of total quality management policy, in order to maintain their competitiveness on nowadays European Union competitive market.