In 1995, Musashino Red Cross hospital started introducing Total Quality Management (TQM) to reduce adverse events and improve the quality of health care. TQM methods have been implemented under consultation to quality management experts at universities or companies. Although Top- down approach is important, Bottom- up activities such as QC Circles are indispensable to pursue TQM practices. Sub- leaders are important for the propagation of the top- leader’s idea and to motivate every member of the staff to act for the leader’s policy. It is necessary to pick up several people having the leadership in the staff. The number of incidents is decreasing by degrees in our hospital. But further efforts are strongly required to improve not only the patient safety but also the much higher quality of health care. Therefore, TQM activities must be continued as daily work.