Abstract
Defining quality of healthcare and determining how to improve organisational performance in developed countries is still an unresolved issue among healthcare professionals. However, given that it is an important area of responsibility and accountability it is no longer acceptable to view the issue as discretionary. An increasingly acceptable operative option for achieving continuous improvement and excellence seems to be the self-assessment of an organisation, based on the principles of knowledge management and total quality management (TQM). This article provides an explanation of a two-level self-assessment approach for implementing TQM within the Spanish healthcare system. The first level integrates a client-centred approach using classical healthcare accreditation criteria along with ISO 9000 standards, the aim being to establish quality assurance systems in the whole organisation. The second level uses the European Foundation for Quality Management Excellence Model as a road map for self-assessment and continuous improvement towards excellence.