Dr. A. Hany Hassanain

You’ll know in this lecture:

The three theories of quality

What theories are applied in the healthcare sector

The interrelationship between the three theories

Assessment of quality on different levels

Quality Concept

In the healthcare services QUALITY

means being effective and efficient in

providing the services and being safe

at a reasonable economic cost.

It does not mean providing service at

any cost for terminal cases

What is meant by effective and

efficient???

Choosing and right thing and doing it

right

Taking the right decision & executing it

right

Effective & Efficient

It stipulates that persons, managers and

quality managers have the ability to take

the proper decision and they also have

the ability to turn these decisions into safe

actions that help to achieve the proper target for the mission.

Quality Concept

In the ER of a hospital the house officers referred 14 cases

to surgery department as acute cases.

They treated 37 cases with different emergency illnesses. The surgeons did 9 operations and discharged 5 patients to

be seen in other specialties. The house officers kept 6

persons under observation for 24 hours but 3 asked to be

discharged after 2 – 4 hours. 12 patients returned after 2 – 8 hours from the 31 that were treated and discharged after

one hour.

Comment on effectiveness and efficiency of the house

officers. (10 minutes)

Example

Effectiveness = no. of successful

decisions / no. of total decisions %

Efficiency = no. of successful work /

no. of total work %

Effectiveness & Efficiency

Three theories: 1. Managerial Breakthrough Quality Control +

Managerial Breakthrough (improving quality in low sectors) + Planning

2. Cycle of Continuous Improvement Managerial Responsibility + Managerial Executive Role + Planning

3. Zero Defect Administration Regulation + Performance Standardization + TQM parameters

Theories of Quality

Which theory or theories are applied in

the healthcare sector?

Could two or more theories be applied in

the same hospital?

The right answer will be commented upon

at the end of the lecture

Quality Control

Managerial Breakthrough (Improving

of low quality sectors)

Planning for Quality

1st Theory – Managerial

Breakthrough

Quality Control

1. Measuring quality Quality parameters

2. Defining the quality level of each sector

3. Knowing the lower quality sector or

sectors to go to step 2 of the theory

Managerial Breakthrough

1. There should be managerial and

administrative responsibility to do that.

2. After improving the low quality sector there should be continuous quality improvement not to return backwards.

3. To know the improvement success one should know the performance of workers so one should know about the performance standardization

Planning for Quality

1. The management plans for the low quality

sector from the low quality parameters to

higher quality parameters .

2. From low performance level to higher

performance level

3. Anything managerial or administrative

should be translated to policies

Managerial Responsibility

Managerial Executive Role

Managerial Planning for TQM

Note: The first theory started with control but this started with

management

2nd Theory – Cycle of Continuous Improvement

Administration regulations

Performance standardization

TQM parameters

Note: It introduced the performance

standardization & TQM parameters

Third Theory

Zero Defect Theory

In Medicine we apply the best available

strategy and we use the three theories in

different departments and sectors of the

hospital but mainly the continuous

improvement theory

Top

Management

Workers

2nd

Theory

Planning

1st

Theory

Control

Breakthrough

3rd

Theory

Standard

Parameters

Which theory or theories are applied in

the healthcare sector?

Could two or more theories be applied in

the same hospital?

The right answer will be commented upon

at the end of the lecture

Part II

Zero Defect Theory

ICU + Operation Theaters

Electric Appliances

Fire Plans

Surgical Operations

Invasive Procedures

TQM parameters are imposed after training

Multiple Control Level

Departments &

Quality

Reliability:

Providing the service without delay with accuracy and the availability of different specialties. This creates a mutual trust. Keeping accurate records is another element of reliability

Time – Specialties – Records

10 Parameters Constitute the TQM in Health Services

Responsiveness:

Rapid response to patients’ needs and the

readiness to help them with response to

their questions. The patient(s) should be told

about the time of service providing.

Time – Communication

Communications:

Between doctors, nurses, secretaries and

patients. Availability of information when

needed

Communication methods – Information

Understanding:

Of patient’s needs and some of his / her

personal problems and the understanding

that patients differ in the needs.

Response to needs when they do not

contradict safety

Access:

Easy accessibility to the hospital by means of

transportation, presence of car barking, and

accessibility to the area of service like the outpatient.

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Credibility:

Reputation of the hospital, credibility about

the outcome of the patient’s condition.

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Competence:

The more highly qualified doctors, the more

experienced, the more skilled nurses are the

more competence for the hospital.

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Security:

Safety and secrecy during receiving the

medical service. Follow up of the patients.

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Empathy:

The priority is for the patient. Some friendship

between workers and some chronic patients

- Giving the patient the enough time

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Tangibles:

Clean building with good design and light

color of walls. Good appearance of the staff.

Recent equipment - Clean cafeterias - Availability of entertainment equipment.

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There are two different standards that should be recognized before TQM program is planned.

Standard measures – could be measured and they represent the work done and the

professionally by which it is done.

Desired measures – they represent what patients expect to have from the hospital.

Medical Quality

Assessment

System Assessment:

Safety measures – number of specialties –

nurses / beds - safety of waste removal –

infection control – readiness for

emergencies, disasters and catastrophes.

Standard Measures –

3 Categories

Process Assessment:

Accuracy of Lab, X-ray and other

investigations reports – efficiency of methods of

diagnosis, efficiency of infection control – drug

dispensary forms – protocols of treatment with

a special reference to the ER and care units –

efficiency of surgical procedures in the hospital

compared with other procedures for the same

illness.

Outcome Assessment:

Mortality and morbidity studies – level of

complications – cure rate for curable diseases

– hospital acquired infection level – hospital

stay days comparing with standards for the

same illness.

Expectation of patients: complaint – surveys – personal meetings.

Perception of patients: the appreciation level of the service - when the patient is

discharged s/he may fill a form about level of

the service.

The Desired Measures

Perception of the hospital’s workers: Questionnaires and surveys to answer the

question of what the administration expect

from the patients.

They do not reflect the appreciation of workers

Absentees

Conflicts

Surveys

Leaving the place

Not following the instructions

Informal organizations

Strikes

Worker’s Satisfaction

What was best in the lecture and what was worst:

A. The teaching part – rank from 1 (worst), 2, 3, 4(best)

B. The Discussion – 1 (worst), 2, 3, 4 (Best)

C. The workshop – 1 (worst), 2, 3, 4 (Best)

D. The Exercise – 1 (worst), 2, 3, 4 (Best)

E. Did you feel bored during the lecture – Yes or No

F. Do you have better understanding of the healthcare business and how it was developed and how will it be developed in the future? Yes or No

Please Rank the Lecturer

Thank

You