Total Quality Management (TQM) is a whole-system approach to safer, better care. This chapter summarizes core principles—patient focus, leadership commitment, staff involvement, process thinking, prevention, and data-driven decisions. Practical guidance centers on hospital implementation. We distinguish continuous (ongoing) from continual (cyclical) improvement and show how both operate on hospital floors. Practical guidance covers hospital implementation: align strategy and clinical governance, build multidisciplinary teams, standardize work, use visual management and reliable measures, and learn from incidents and patient feedback. We outline the attributes of a quality culture (psychological safety, just culture, transparency) and the role of quality circles in local problem-solving and spread. Leadership gets specific: behaviors that coach, listen, remove barriers, and model accountability; styles that blend transformational and servant leadership. Lean’s human-centred practices - respect for people, co-design with staff and patients, and waste removal across value streams, improve efficiency and collaboration. Finally, how process improvement and change management move together, turning ideas into sustained results is explained.