1

Quality Management in Healthcare

HIM 403

Unit 1

Introduction to Quality Management Terms, Principles

& Implication in Healthcare
This unit covered CLO 1:
Explain the principles of quality management and the role of quality management in performance improvement in healthcare.
 Chapter Outline
 What does the term quality mean?
 Quality perspective among different Stakeholders
 Six dimensions/ components of quality in healthcare
 The importance of quality
 The Three Quality Pioneers
 What is TQM?
 Rise of TQM
 Principles of total quality
 THE philosophy of TQM
 Quality assurance
 Performance Excellence
 Healthcare Concept
 Healthcare Concept
 What’s wrong in today’s Healthcare?
 What can we do about wrong issues?
 Definition of healthcare quality
 The Consequences of Poor Quality
 Quality Planning
 Responsibility for Quality
 Costs of Quality
 UAE concentration on quality healthcare: Strategic Priorities
What does the term quality mean?

 Quality is the ability of a product or

service to consistently meet or exceed
customer expectations.
Quality perspectives among
different stakeholders
 Ideally, all stakeholders should have a
common basis for assessing care, but
often, their opinions on quality of care
vary; they judge quality differently and
value different components of the
quality of care.
 There may even be conflicting opinions
between and within different
stakeholder groups as to what quality
means in healthcare services.
Quality perspectives among different
stakeholders- Con’d
 Quality perspectives among different
stakeholders- Con’d
 The concept and vocabulary of quality are
elusive. Different people interpret quality
differently. Few can define quality in measurable
terms that can be proved operationalized. When
asked what differentiates their product or service;
The banker will answer” service”
The healthcare worker will answer “quality
health care”
The hotel employee will answer “customer
satisfaction”
The manufacturer will simply answer “quality
product”
Quality perspectives among different stakeholders-
Con’d
Client:
 Relief from the ailment
Service & Treatment with compassion
The ability and capacity of healthcare to satisfy
the client’s needs
Provider:
Offering state of the art-- technical care
Outcome comparable to known standards
Protection from legal systems
The Managerial Perspective:
Doing the right thing right, right away,
 Quality perspectives among
different stakeholders- Con’d
Government officials and policy makers
These are the people who can develop, pass, and
enforce laws and regulations that may either fulfill the
goals of your effort or directly cancel them out.
Legislators. Federal and state or provincial
representatives, senators, members of parliament, etc.
who introduce and pass laws and generally control
public budgets at the federal and state or provincial
levels.
Governors, mayors, city/town councilors, selectmen,
etc. The executives that carry out laws, administer
budgets, and generally run the show can contribute
greatly to the success – or failure – of an effort.
Quality perspectives among
different stakeholders- Con’d
• Local board members: Boards of health,
planning, divisions, etc., through their power
to issue permits and regulations, can be crucial
allies and dangerous opponents.

• Policy makers. These people or groups often

have no official power – they may be
“advisers” to those with real power – but their
opinions and ideas are often followed closely.
If they’re on your side, that’s a big plus.
Determinants of client’s expectations

 Nature of medical illness.

 Past experience in the same set up.
 Experience at other set up.
 Financial and social standing.
 Level of education.
Six dimensions/ components of quality
in healthcare
Six dimensions/ components of
quality in healthcare- Con’d
• Safe: Avoiding harm to patients from the
care that is intended to help them.
• Effective: Providing services based on
scientific knowledge to all who could benefit
and refraining from providing services to
those not likely to benefit (avoiding
underuse and misuse, respectively).
• Patient-centered: Providing care that is
respectful of and responsive to individual
patient preferences, needs, and values and
ensuring that patient values guide all clinical
decisions.
Six dimensions/ components of
quality in healthcare- Con’d

• Timely: Reducing waits and sometimes

harmful delays for both those who receive
and those who give care.
• Efficient: Avoiding waste, including waste of
equipment, supplies, ideas, and energy.
• Equitable: Providing care that does not vary
in quality because of personal
characteristics such as gender, ethnicity,
geographic location, and socioeconomic
status.
 The importance of quality in
healthcare
 Unification in Process
 Standards and Norms
 Reduce Error, Reduce waste
 Reduce Cost
 Accreditation
 Legal issues
 Consumer protection
 Increased motivation, this is what satisfies
people
 Right thing to do (Hippocratic oath)
The importance of quality in healthcare -
Con’d

 Performance measurement
 Customer satisfaction
 Utilizationof resources & cost
effectiveness
 Improves the health status
 Social and economic benefits
 The Three Quality Pioneers
Deming:
the best known of the “early” pioneers, is
credited with popularizing quality control in
Japan in early 1950s.Today, he is regarded as a
national hero in that country and is the father of
the world-famous Deming prize for quality.
The Three Quality Pioneers Con’d

Juran:
Juran, like Deming was invited to Japan in
1954 by the union of Japanese Scientists
and engineers.

Juran defines quality as fitness for use in

terms of design, conformance, availability,
safety and field use. He focuses on top-
down management and technical methods
rather than worker pride and satisfaction.
The Three Quality Pioneers Con’d

Philip Crosby: author of popular book

Quality is Free. His absolutes of quality
are:
Quality is defined as conformance to
requirements, not “goodness”
The system for achieving quality is
prevention, not appraisal.
The performance standard is zero
defects, not “that’s close enough”
The measurement of quality is the price
of non-conformance, not indexes.
What is TQM?

TQM is a broad management

philosophy, adopting quality and
leadership commitment, which
provides the energy and the
rationale for implementation of
the process of continuous quality
improvement within the
organization wide quality strategy.
 Rise of TQM
 Now days, Healthcare systems are of
fundamental interests to all level of HSOs in
our societies.
 Eventually,increasing importance and reliance
are placed on total quality management in
healthcare systems. Due to this rising
importance that is also reflected in the
increasing percentage of national and
international resources for both private and
public sector to allocated in hospital
management systems.
Rise of TQM- Con’d

 Hospitals and other healthcare

organization across the globe have
been progressively implementing TQM
to reduce costs, improve efficiency and
provide high quality patient care.
 Principles of total quality

 Customer and stakeholder focus

 Process orientation
 Continuous improvement and
learning
 Employee engagement and teamwork
 Management by fact
 Visionaryleadership and a strategic
orientation
 The philosophy of TQM

 TQM focuses on identifying root causes of

quality problems and correcting them at
the source.
 Not only does TQM encompass the entire
organization, but it stresses that quality
is customer driven.
 TQM attempts to include quality in every
aspect of the organization.
 It is concerned with technical aspects of
quality as well as the involvement of
people in quality, such as customers,
company employees, and suppliers.
 System

MANAGEMENT OF
PROCESS QUALITY

CUSTOMER
FOCUS
Driver HUMAN RESOURCE AND
DEVELOPMENT AND SATISFACTION
MANAGEMENT
SENIOR
EXECUTIVE
LEADERSHIP
STRATEGIC
QUALITY QUALITY
PLANNING AND
OPERATIONAL
RESULTS
INFORMATION
AND ANALYSIS

System Approach for TQM

 Quality assurance (QA)

It is the process by which health entities

ensure outsiders that their products meet
expected or required quality standards.
It is the overall philosophy in these entities.
The Implication of QA
 Qualityassurance in healthcare is a vital
component of the industry.
 Qualityassurance is related to the requirements
and goals for a service.
 Quality assurance in healthcare includes the
activities and series of measures that are
designed to ensure continuous improvement in
the quality of medical care.
 Such programs not only improve the clinical
outcomes but also help increase staff
engagement & improve the organization's
overall standing.
The Implication of QA
 The importance of delivering quality patient care is
interrelated with the economic success of a healthcare
organization.
 The improvement efforts may include:
1. Internal audits,
2. Independent performance audits.
3. Consumer reports,
4. Outcomes analysis,
5. Customer satisfaction surveys.
6. The National Committee for Quality Assurance (NCQA)
accreditation.
7. Quality assurance software.
8. Testing internal systems for healthcare facilities
 Elements of QA
There must be a system for establishing professional
standards
 Standards of behavior
 Standards of organization
 Standards for measuring professional practice
There must be a system of surveillance so that one can
know if the predetermined standards are being met
There must be a system of enforcement of those
standards
 There has to be action all the way from adherence
to those professional standards through structured
educational programes, right up to the point of
direct and very prompt exercise of authority wen
the safety of the patient is at stake.
QA Accountability

QA organizational structure
A broad level committee ultimately
responsible for the overview of the
hospital-wide QA programme
A medical staff committee structure
and communication process to
accommodate data collected on the
process of care delivered
QA Accountability- Con’d
A hospital wide committee or
communication structure that ensures the
review of all support service care delivery.

A multidisciplinary forum comprised of

clinical and non-clinical staff to resolve
issues that cross departmental lines.

A centralized data collection/coordination

process to ensure systematic
comprehensive review of the system of
patient care delivery
Evaluation of QA
 Quality is provided by mix of complex
human and technological resources
(multidisciplinary).

 Essential to have a coordinated

structure that facilitates communication
on patient care activities.

 Enhancing multidisciplinary problem

solving and providing accountability
throughout the process
Relationship of quality to performance:
Performance Excellence
Performance Excellence is an integrated
approach to organizational performance
management that results in delivery of
ever-improving value to customers and
stakeholders, contributing to
organizational sustainability,
improvement of overall organizational
effectiveness and capabilities, and
organizational and personal learning.
Relationship of quality to performance:
Performance Excellence- Con’d
 Asset Performance Excellence is all about looking at
the bigger picture! An “Asset Performance
Management System” can have a very precise process
that lets you define and manage your losses, assess
your organization’s problems, and create the right plan
for a solution.
 Performance Excellence demands the unified
partnership relationship between functions that are
essential to operating a production/manufacturing
operation effectively and efficiently to maximize
healthcare outcomes & profitability.
The components of Performance Excellence
 Healthcare concept
 The system that a Nation has built up and
continuously maintains in order to combat
(unnecessary) Death, Disease,
Disability ,Dissatisfaction and (social)
Disruption
 A collection of curative, preventive,
rehabilitative and promotive services
 Health care is a social and economical quest
encompassing activities by providers,
consumers, financiers and government within
their respective value systems
What’s wrong in today’s Healthcare?

 Avoidable errors
 Underutilization of services
 Overuse of services
 Variation in services
 Communication problems
 Lack of Evidence
 Dissatisfied clients
What can we do about wrong issues?

 Do nothing
 Better education and training
 Policing, Inspection, Punishment
 Change, Improve, Reward
 Comprehensive Approach: Quality
Assurance
The Consequences of Poor Quality
 Loss of business
 Liability
 Low Productivity
 High costs

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 Costs of Quality
 Failure Costs - costs incurred by
defective parts/products or faulty
services.
 Internal Failure Costs
 Costs incurred to fix problems that
are detected before the
product/service is delivered to the
customer.
 External Failure Costs
 All costs incurred to fix problems
that are detected after the
product/service is delivered to the
customer.
Quality Planning

 Establish Quality project: goals and

team
 Identify customers
 Determine client needs
 Design services to be provided
 Design delivery process
 Determine information need
 Use and evaluate
Responsibility for Quality

 Top management
 Design
 Procurement
 Production/operations
 Quality assurance
 Packaging and shipping
 Marketing and sales
 Customer service
Costs of Quality- Cont’d
 AppraisalCosts
 Costs of activities designed to
ensure quality or uncover defects

 Prevention Costs
 All TQ training, TQ planning,
customer assessment, process
control, and quality improvement
costs to prevent defects from
occurring

9-43
UAE concentration on quality healthcare:
Strategic Priorities
 Health System Strengthening:
Strengthening the health system and
building national capacity in the Ministry
of Health and Health Authorities;
strengthening partnerships.

 Promoting health through the Life

Course approach: Collaborating on
health promoting schools and adolescent
health; continuing collaboration on
occupational and environmental health.
UAE concentration on quality healthcare:
Strategic Priorities –Con’d
 Expanding surveillance, prevention
and control of non-communicable
diseases; strengthening road safety and
prevention of road traffic crashes and
injuries.

 Strengthening
prevention and control of
communicable diseases.
 Strengthening national capacity for
health preparedness and response in
emergencies and natural disasters.
Conclusion

 Remember the earth revolves around

the CUSTOMER. Quality generates
customers and customers generates
quality.

 Let us all have action plans to support

quality, this will make the world happy
and earn us the blessing of God
Almighty.