Abstract

This paper examines some of the processes which have contributed to the development of a ‘total quality’ (TQ) approach within British health care. The paper challenges the idea that TQ is part of a redistribution of power within the NHS. Rather it is argued that through the elaboration of consumer-led market identities TQ misrepresents the interests of management and constructs a version of the self which obscures new forms of management control. TQ constrains alternative forms of social organisation, local knowledge and the social interests invested in them. An example of a competing set of assumptions is discussed. It is suggested that clinical groups — who are primarily motivated by the principles of professional, collegiate control — seek to free themselves from the constraints of TQ. Thus clinical discourse appropriates a professionally led version of the market and protects the traditional autonomy of professionals whilst seeming to render their interests synergistic with those of management. This casts ‘quality’, and perhaps even the ‘market’, as conceptual sites upon which different groups strive to construct and legitimate their own interests. It is concluded that the changes explicitly associated with TQ are not as fundamental as they seem