Implementing TQM in a medical school department

In a modest way, our medical school department has succeeded in applying continuous quality improvement and TQM methods to its ambulatory practice. We are close enough to our experience not to have forgotten what Rosabeth Moss Kanter calls the "messy, mistake-ridden, muddling stage." This article is a narrative of some of our stumbling attempts to change the way our practice works. The lessons we have learned are relevant to other ambulatory practices, both inside and outside the academic world.