Introduction
The rapid growth and the dramatic changes in the hospital industry are challenging healthcare managers to find alternative ways of remaining viable. CQI is recognised as the winning strategy in today's rapidly changing and competitive healthcare environment. In our paper, "Total Quality Management in Practice: A Singapore Healthcare Study", the authors have recommended that hospitals should evaluate their existing TQM processes and activities and the result should be used to form the basis for the policymaking process. However, a hospital would need to identify and articulate the expectations and perceptions of their customers before they could evaluate the effectiveness of their TQM processes and activities. The problem is that learning how to elicit customers' expectations is not an easy task for an industry that has always assumed it knows what the customer needs. While it is clear to all healthcare managers that the financial incentives have changed and the "golden days" of medicine are over, answers about how to respond to customers' expectations are few and far between. Some researchers have argued that the application of TQM may offer a partial solution (Geber, 1992; Anderson, 1992; Fried, 1992; Lawrence and Early, 1992 and Bergman, 1994). This is because TQM is a process which embraces the conscious striving for zero defects in all aspects of an organisation's activities or management with workforce co-operating in the processes, developing, producing and marketing quality goods and services which satisfy customers' needs and expectations first time and every subsequent time (Haigh and Morris, 1993). TQM is also a system or process to improve both efficiency and quality through continuous improvement of the delivery of patient care and of the