Singapore hospitals are attempting to adopt a Total Quality Management (TQM) philosophy and a customer orientation strategy to meet customer's demand for higher quality. An earlier study by Yap on Quality Assurance in Singapore hospitals failed to adequately establish the contributions of Quality Assurance in improving customers' satisfaction. Against this background, the central thrust of this exploratory research project involves the identification of: (1) the need for a common definition of quality within a hospital, (2) the principles of TQM and a critique of orthodox TQM implementation models of the Gurus and TQM writers; (3) TQM tools and the applicability of Quality Function Deployment in the development of a total quality model. Information was obtained on the research areas through: (1) extensive review of Quality Management literature; (2) questionnaire surveys investigating the management quality practices in Singapore hospitals, patients and doctors/staff expectations and perceptions of hospital service quality, and the critical success factors for the implementation of the total quality model; (3) structured interviews and focus group sessions investigating the specific management quality activities and service elements adopted by 3 Singapore hospitals; (4) case studies to demonstrate the wide applicability of QFD as an organisational tool in healthcare. The adoption of this Action Research methodology identified that service quality in Singapore hospitals is generally below patients' expectations. These gaps arose from the failure in understanding the voice of the customer, which is itself symptomatic of the need for a holistic TQM model. In the final analysis, this research project, as a major contribution to knowledge in the quality management field, provides the first empirically developed total quality healthcare model using the QFD tool. This represents the first holistic QFD-led total quality model validated by the experiences of 30 focus group members and 2 top level executives of Singapore hospitals. In addition, a framework involving infrastructure and measurement management to implement the proposed model is offered.