1. Introduction

With the increasing demand for medical and health care and the rapid development of medical technology, quality management of clinical processes has become a core issue in improving medical service efficiency and ensuring patient safety. Total Quality Management, as a management philosophy and practical approach, aims to optimize organizational efficiency and competitiveness through continuous quality improvement and customer satisfaction enhancement. In clinical settings, the implementation of TQM involves interdisciplinary team collaboration, process optimization, risk management, and patient-centered nursing concepts.

Although TQM has significant theoretical advantages, it faces many challenges in the actual clinical process. From imbalanced resource allocation to obstacles in the application of information technology, to insufficient training and participation of medical staff, these issues may all affect the effective operation of the comprehensive quality management system. In addition, existing research has pointed out that problems such as poor communication, low standardization of processes, and lack of regulatory mechanisms in clinical practice seriously constrain the effectiveness of comprehensive quality management strategies.

Therefore, this study aims to explore in depth the problems faced by implementing Total Quality Management in clinical processes, and propose corresponding optimization strategies based on empirical research and theoretical analysis. Through a review of existing literature, observations of clinical practice, and interviews with key stakeholders, this article will reveal the key factors affecting clinical total quality management and propose practical and feasible improvement measures. These measures are not only expected to improve the internal management and operational processes of medical service providers, but also contribute to increasing the overall satisfaction and trust of patients in medical services.

2. Literature review

The application of Total Quality Management in clinical processes has always been a focus of research in the field of medical management. Since the second half of the 20th century, the concept of TQM has been widely promoted and applied in multiple industries such as manufacturing and service, aiming to improve the overall performance and customer satisfaction of organizations through continuous improvement processes. With the development of time, this concept has also been introduced into the field of healthcare, committed to improving the quality of medical services and patient safety.

Early research on the application of TQM in clinical processes focused on process optimization and strategies to reduce medical errors. Donabedian (1988) proposed three dimensions of quality care: structure, process, and outcome, laying the foundation for subsequent research. Subsequent research further explored how to enhance the effectiveness of TQM implementation through cross functional team collaboration, patient engagement, and the use of information technology (Langley et al., 1996).

Although the TQM concept is highly respected in theory, it still faces many challenges in practice. Bateman et al. (2001) pointed out that healthcare institutions face obstacles in resource allocation, employee training, leadership support, and cultural change, which affect the effective implementation of TQM. On the other hand, the study by Jakimowicz and Fowler (2003) emphasizes that poor communication and insufficient team collaboration are key factors that make it difficult to implement TQM in the clinical process.

In recent years, some studies have focused on evaluating the impact of TQM on specific medical procedures, such as surgical procedures (Taylor et al., 2014) and chronic disease management (Manory et al., 2013). These studies show that when combined with specific clinical practices, Total Quality Management can significantly improve the quality and efficiency of patient treatment.

In terms of solving strategies, many scholars suggest adopting a multi-dimensional approach to overcome the problems in TQM implementation. Wagner et al. (2012) advocate the use of data-driven methods to guide clinical decision-making and promote the implementation of best practices through continuous quality improvement. In addition, Grol and Griffin (2017) emphasized the importance of leadership in their framework, as well as creating a supportive environment at the organizational level to promote change [1].

In summary, although Total Quality Management has enormous potential value in the clinical process, its implementation faces numerous complex challenges. Existing literature provides a deeper understanding of these challenges and proposes diverse solutions. Future research needs to continue exploring how to effectively implement and maintain TQM in a constantly changing medical environment, ensuring that it becomes a powerful tool for improving clinical quality and patient safety.

3. The problems faced in implementing total quality management in the clinical process

When implementing Total Quality Management (TQM) in clinical practice, there are a series of issues that can be analyzed from multiple perspectives such as resources, processes, personnel, and systems.

3.1. Uneven distribution of medical resources

The uneven distribution of medical resources is a key issue that is widely faced globally, especially in developing countries, where this imbalance is particularly prominent. In China, due to differences in historical development, economic level, and geographical location, there is a significant imbalance in medical resources between urban and rural areas, as well as between the eastern coastal and western inland areas. High quality medical resources such as large comprehensive hospitals, advanced medical equipment, and top medical talents are often concentrated in economically developed big cities. In contrast, medical facilities in small and medium-sized cities, township health centers, and rural areas are relatively backward, and high-level medical personnel are scarce, which directly leads to regional differences in the accessibility and quality of medical services.

Although the country has implemented a series of policies to promote the sinking of medical resources to the grassroots level, the implementation effect of these policies still needs time to be observed and evaluated due to inadequate financial investment, talent mobility mechanisms, and supporting measures. For example, the policy of supporting county-level hospitals through resource sharing and technical support in tertiary hospitals aims to enhance the service capabilities of grassroots medical institutions [2]. However, this process requires overcoming various challenges, including long training cycles for medical talents and insufficient incentive mechanisms.

3.2. Inconsistent quality control standards

In the clinical process, Total Quality Management faces the challenge of inconsistent quality control standards. This challenge affects the overall effectiveness and safety of medical services, limiting the improvement of medical quality. Due to differences in historical development and management systems, there may be differences in quality control standards among different hospitals or even different departments within the same hospital [3]. This inconsistency leads to diversity in medical practices, resulting in uneven quality of treatment received by patients in different medical institutions. For example, differences in surgical procedures, drug use standards, infection control measures, and other aspects may have an impact on the treatment effectiveness and safety of patients. The lack of unified quality control standards also poses obstacles to cross institutional collaboration. In the multidisciplinary team collaboration treatment model, if there is inconsistency in the understanding and application of quality standards among all parties, it may lead to problems in the execution of the treatment plan, affecting the comprehensive treatment effect of patients. With the innovation of medical service models and the application of information technology, how to adapt traditional quality control standards to modern medical service needs is also an urgent problem that needs to be solved. For example, the emergence of emerging service models such as telemedicine and artificial intelligence assisted diagnosis has put forward new requirements for quality control standards.

3.3. Insufficient training and education

The lack of training and education is a significant obstacle to the implementation of Total Quality Management in clinical processes. In the medical field, the speed of updating professional knowledge and technology is extremely fast, requiring medical personnel to continuously learn and improve their skills. However, in reality, medical personnel often cannot attend sufficient training courses due to heavy workloads and insufficient time, or lack learning opportunities due to the lack of necessary learning resources and support provided by their institutions.

Even if there are training opportunities, the content and form of these trainings may not always be closely related to the actual work needs of medical personnel, resulting in poor training effectiveness [4]. For example, some training may be too theoretical and lack practical operations, making it difficult for medical personnel to apply the knowledge they have learned to practical work. At the same time, the allocation of training resources is often uneven, and doctors and nurses in primary medical institutions may have difficulty obtaining education opportunities at the same level as large hospitals.

The inadequacy of the Continuing Medical Education (CME) system is also a problem. CME aims to ensure lifelong learning and career development for healthcare workers, but in some regions or institutions, this system has not yet been established or is not sound enough, resulting in a lack of systematic ways for healthcare workers to regularly update their knowledge and skills.

3.4. Lack of reward and punishment system

The lack of an effective reward and punishment system in the implementation of Total Quality Management (TQM) in clinical practice is an issue that cannot be ignored. The lack of this system may lead to a lack of necessary incentives and constraints for medical personnel in their work, thereby affecting the quality and safety of medical services.

Medical work is a highly specialized and demanding job, and medical personnel need to possess rich professional knowledge and skills. However, due to the lack of a reward and punishment system, some medical personnel may not take their work seriously and be responsible enough, resulting in errors or negligence in their work. This will not only affect the treatment effectiveness and safety of patients, but also damage the reputation and credibility of medical institutions.

The lack of a reward and punishment system may lead to insufficient competition among medical personnel. In some medical institutions, due to the lack of clear reward and punishment mechanisms, medical personnel may lack sufficient motivation to improve their professional skills or actively participate in quality improvement activities [5]. This situation is not conducive to creating a good working atmosphere and teamwork spirit, nor is it conducive to improving the quality of medical care.

The lack of a reward and punishment system may also lead to the waste of medical resources. In the absence of a clear reward and punishment mechanism, some medical personnel may not actively take measures to improve work efficiency or save resources. For example, they may not pay attention to reducing unnecessary examinations or reusing disposable medical devices. This kind of waste not only increases the cost burden on medical institutions, but may also cause unnecessary economic pressure on patients.

3.5. Insufficient application of technology and tools

The inadequate application of technology and tools is a key issue facing the implementation of Total Quality Management (TQM) in clinical processes. With the rapid development of medical technology, various advanced technologies and tools continue to emerge, providing enormous potential for improving the quality of medical services [6]. However, in practical applications, healthcare professionals may face many challenges that prevent these technologies and tools from fully utilizing their potential.

Rapid technological updates may make it difficult for healthcare professionals to keep up with the latest developments. Even if there is a willingness to adopt new technologies, it may be limited due to a lack of training or resources. In addition, some medical institutions may lack sufficient funds to purchase expensive medical equipment or software, thereby limiting the application of advanced technology.

4. Optimization strategies for Total Quality Management in clinical processes

4.1. Optimize resource allocation

Optimizing resource allocation is a key measure to achieve equalization of medical services and improve overall medical quality. When facing the challenge of imbalanced distribution of medical resources, a series of comprehensive strategies must be adopted to ensure that resources can be more fairly distributed to every place that needs them.

The government and relevant health departments should establish clear policy frameworks to encourage the flow of medical talents to rural areas and resource scarce areas. This can be achieved through providing professional training, signing service agreements, and establishing incentive mechanisms such as providing housing subsidies, preferential treatment for children's education, and priority for career advancement. Through the implementation of these policies, the enthusiasm of medical workers to work at the grassroots level can be stimulated, thereby gradually improving the problem of uneven geographical distribution of medical talents.

Increase financial investment, upgrade and transform medical facilities in small and medium-sized cities, township health centers, and rural areas, introduce modern medical equipment and technology, and improve the medical service capabilities of these areas. At the same time, by constructing and improving infrastructure such as transportation and network communication, we can promote the mobility and accessibility of medical resources.

Develop a telemedicine service system, and provide expert consultation, medical image analysis, continuing education and other services for remote areas by using information technology means such as the Internet, big data, cloud computing, etc. Remote healthcare not only shortens the distance between patients and experts, but also effectively saves time and economic costs, allowing high-quality medical resources to be fully utilized.

In addition, it is necessary to establish and improve a mechanism for sharing medical resources, such as promoting cooperation and resource sharing between large hospitals and grassroots medical institutions in the region, including sharing medical equipment, exchanging professional talents, and discussing cases, in order to improve the level of grassroots medical services.

4.2. Unified quality control standards

Unified quality control standards are the core link to ensure homogenization of medical services and improve overall medical quality. Facing the current situation of incomplete and inconsistent medical quality control system in China, it is particularly urgent to establish a unified national medical service quality control standard. The development of this standard needs to be based on the principles of evidence-based medicine, combined with best practices and guidelines at home and abroad, led by the National Health Commission, and involving experts from professional associations, medical institutions, and academia.

Key indicators for quality control should be clearly defined, including clinical diagnosis and treatment, patient safety, service efficiency, and patient satisfaction, to ensure that these indicators are operable and measurable. At the same time, it is necessary to consider the possible differences in the implementation of standards among medical institutions of different levels and types, and develop corresponding implementation rules and guidelines.

Strengthen the promotion and education of unified quality control standards, and enhance the awareness and understanding of these standards among medical workers through organizing seminars, training courses, online courses, and other forms. In addition, modern information technology tools such as electronic medical record systems and quality management software should be utilized to help healthcare professionals better apply these standards in their daily work.

4.3. Strengthen training and education

Strengthening the training and education of medical personnel is the cornerstone of improving the quality of medical services in the implementation of Total Quality Management (TQM). The rapid development of the medical field requires medical personnel to constantly update their knowledge, master new skills, and adapt to new treatment and management methods. To this end, medical institutions and policy makers must work together to establish a systematic and sustainable education and training system.

Clear plans for continuing education and career development should be established to ensure that all medical personnel receive regular training on the latest medical knowledge and skills. This includes updating basic medical knowledge, improving clinical skills, learning emerging treatment methods, and enhancing medical ethics and patient communication skills. The government and professional associations can introduce standardized training courses and ensure the quality of education through certification mechanisms.

4.4. Establish a reward and punishment system

It is crucial to establish an effective reward and punishment system in the implementation of Total Quality Management (TQM). The main purpose of this system is to ensure that the work performance of medical personnel is closely linked to the overall goals of medical institutions and the health outcomes of patients, while motivating medical personnel to make positive efforts in improving service quality.

Medical institutions need to establish clear performance evaluation standards that cover all aspects of medical services, including clinical operational skills, patient satisfaction, work efficiency, and the learning and application of new knowledge. The design of the evaluation system should be scientific and reasonable, and can fairly reflect the work performance and contribution of medical personnel.

Based on the results of performance evaluation, medical personnel who perform outstandingly will be given material rewards and spiritual encouragement. Material rewards can include bonuses, promotion opportunities, additional holidays, etc., while spiritual encouragement includes public commendation, awarding certificates of honour, etc. These reward measures can improve the job satisfaction and loyalty of medical personnel, and stimulate their motivation to continuously improve their work.

4.5. Promoting the application of technology and tools

Medical institutions should actively pay attention to the latest developments in medical technology, evaluate and introduce technologies and tools that can improve work efficiency and improve patient treatment outcomes. This includes electronic medical record systems, remote monitoring devices, precision medical tools, etc. At the same time, institutions need to invest necessary financial support, including purchasing equipment, software, and paying maintenance and upgrade fees.

Encourage medical personnel to actively participate in the selection and evaluation process of new technologies, making them participants in technology application rather than passive recipients. This not only increases their acceptance and willingness to use new technologies, but also enables them to better understand the advantages and limitations of new technologies, thus making more effective use of these tools in practical work.

5. Conclusion

The implementation of Total Quality Management is a complex process that requires the joint efforts of medical institutions, governments, professional associations, and medical personnel. The balanced allocation of medical resources, unified quality control standards, strengthened training and education, establishment of reward and punishment systems, and promotion of the application of technology and tools play a crucial role in improving the quality of medical services. These strategies are interrelated and together constitute a systematic and multidimensional quality management system, aimed at continuously improving the overall efficiency and effectiveness of medical services, ensuring patient safety, and enhancing patient satisfaction. Through continuous quality improvement, technological innovation, and respect and cooperation with all relevant parties, we can truly optimize medical services and provide patients with safer, more efficient, and satisfactory medical services. In the future development of healthcare, Total Quality Management should become the core mission and pursuit of every medical institution, in order to promote the development of the entire healthcare industry to a higher level.