Explores the Total Quality programme adopted by the National Health Service, highlighting the issues which make sustaining the commitment of all staff to quality improvement processes possible. Discusses the tension created by linking quality improvement to reducing quality costs of health care. Outlines the timetabling of strategy development and implementation, and the management of he timetabled process. Reviews key milestones in staff awareness, looking at co‐ordination and management of quality improvement activities; understanding of the design/conformance/corrective action cycle; understanding of the relationship between quality improvement and costs; and sustaining involvement of staff. Suggests that despite concerns from clinicians and managers alike, regarding the pressures involved with implementing TQM, a successful team should improve service to the patient.