The overall objective of this study was to determine TQM application in health systems of different countries and designing an appropriate model for Iran through experimenting in Hamadan Province District Health Systems. Its most important special objectives were: analyzing action plan for TQM and the achievements in different countries –including IRAN, primary
   modeling TQM and proposing it for health systems, experimenting of the mentioned above model in 8 DHSs` of Hamadan province , analyzing the results of applying TQM and at the end proposing appropriate strategy for successful implementation of TQM.

          This research was a semi exprimental study that after one year from applying proposed model in 8 DHSs` of Hamadan Province short-term results were evaluated. The results showed a positive change in organizational culture, teamwork, process oriented and customer satisfaction in the trial field. In a way that 42.5% of responses agreed with cultural change in  organization, 45.5% claimed increasing of teams problem solving effectiveness. As a necessiation technical aspect of quality improvement
   projects, process capability ratio (PCR), in some process was dramatically increased, in a way that PCR in vaccination process(from 0.8 to 1.08) , health card issued(from 0.82 to 1.71), child care(from 0.5 to 1.3), health house reports(from 0.24 to 1.5) and delivery of LD&HD pill (from 0.41 to 1.48) improved. The most driving forces capable of affecting success of TQM were: committed and supportive management (87%), continuous education (85%), Strategic planning(73%),and Employee participation(65%).

          Considering the maintained above results, TQM implementation in Hamadan province district health systems, not only increased quality of key processes, but also created positive culture change.