Total Quality Management in Healthcare

Presented By:

Gunjan Patel Student – MS (Medical Software)MCIS, Manipal

B.E.-Bio-Medical EngineerPGD-Quality Management

National Conference Information Science -2009

World without word “Quality”

• People and Organizations must behave morally Sensitivity toward – Social– Cultural– Economic– Environmental issues

Motivation

• Literature view• Definition• The importance of Total Quality• TQM movement in Healthcare• TQM principles• Quality Assurance and control• Tools for Process Management• Lean and Six Sigma concepts in Healthcare• References

Literature view

• In 19 century: The root of quality assurance initiatives in healthcare Florence Nightingale’s as far back

• In 1913 : The American College of Surgeons (ACS) was founded great variations in the quality of healthcare

• By 1917 and 1930 : The ACS developed the Hospital Standardization Process`

• By 1992: The American Society for Quality's (ASQ) Healthcare played role of improving healthcare quality.

• By 1997 : Quality Council of India (QCI) was established as an autonomous body - National Accreditation Board

for Hospitals and Healthcare Providers (NABH)

What Is Quality?

The American National Standards Institute (ANSI) and American Society Quality (ASQ) define quality as

“The totality of features and characterizes of a care or service that bears on its ability to

satisfy given needs”

• According to Crosby, Quality is

“Conformance to Requirements or Specifications”

The Importance of Total Quality

• Total Quality of performance that is directly related to healthcare safety, security, attitude staff, role of doctors in terms of ‘time’ includes appointment, delay time, service time, timing with regards to medical treatment and surgery.– Quality of administration and management – Quality of doctors and supporting staff– Quality of hospital care

TQM Movement in HealthCare

• Hospitals and other healthcare organization across the globe have been progressively implementing TQM to reduce costs, improve efficiency and provide high quality patient care.

• TQM, which places on improved customer satisfaction, offers the prospect of great market share and profitability.

• TQM can be an important part of hospitals competitive strategy in quality of healthcare system.

TQM Principles

• Customer focused organization• Leadership• Involvement of people• Process approach• System approach to management• Continual Improvement• Factual approach to decision making• Mutually beneficial supplier relationships

• Customer focused organization– Organizations depend on their customers – Understand current and future customer needs– To meet customer requirements – Make every effort to exceed customer expectations

• Leadership– Leaders establish unity of purpose and direction– Create and maintain the internal environment – People can become fully involved in achieving the

organization's objectives

• Involvement of people– Every team member can assure good quality– Managers and staff members have solve problems

and recommend improvements

• Process approach– Organization as a collection of interdependent

systems and processes– Managers can study and solves problem use tools

and techniques for process

• System approach to management– Identifying, understanding and managing a system– The process of system contributes to the

organization’s effectiveness and efficiency in achieving its objectives.

• Continual improvement– Never ending process in system :

• Plan – Do –Check – Action

– Overall performance should be a permanent objective of the organization.

• Factual approach to decision– Collecting and Analyzing :

• accurate, timely, and objective data

– Managers can solve organizational problems and decision to measure progress

• Mutually beneficial supplier relationships – An organization and its suppliers are interdependent – Mutually beneficial relationship enhances the ability

of both to create value.

Deming principles to healthcare Systems

• Insists on zero defects eliminate inspection through proper quality control on suppliers.

• Constant improve the system• Educational and Training program• Maintain the records• Eliminate numerical goals, work standards and slogans• Remove the barriers that hinder the worker through

the day• Top management support for implementing TQM

Quality Assurance

• Planned activity or systematic approach to provide adequate confidence of healthcare and service

Quality Control

• Ensures that planned activities to take place as per quality design

– Measuring quality process– Timely data collection and analysis – Effective supervision

Tools for Process Management

• The tools and techniques, that Support Quality Management within the organizational fundamental components of TQM

• 7 Basic Quality techniques:– Cause and Effect Diagrams

– Flow Charts– Histograms– Pareto Charts– Run Charts– Control Charts– Scatter Diagrams

Cause and Effect Diagrams• The relationship between Effects and the categories of their

causes• The Arrangement of the Diagram lets it look like a fishbone it

is therefore also called Fish-Bone diagram• Determine the Effect or Problem you would like to examine

Categorize the possible causes

effecteffect

ManManMachineMachine

MethodMethodMeasurementMeasurementProcessProcess

SystemSystem

Flow Charts• Way of representing a Procedure using symbols and arrows • A Flowcharts shows the activities in a process and the

relationships between Operations and Decisions • A Flow chart lets a process or procedure be understood easily

it also demonstrate the relationships between all elements

InputInput WithinSpec?WithinSpec?ProcessProcess OutputOutput

adjustadjust

YesYes

NoNo

Histograms

• A Histogram is a bar graph • Usually present frequency data • Histograms provide an easy way to evaluate the

distribution of Data over different categories

Pareto Charts

• A Pareto Chart is a Histogram + a cumulative line • Pareto Charts are used to apply the 80/20 rule of Joseph Juran which

states that 80% of the problems are the result of 20% of the problems. A Pareto Chart can be used to identify that 20% route causes of problem.

• Now determine the point were the cumulative line crosses the 80% mark. Concentrate of the failure types that lie left of this mark.

Time

Mea

sure

men

t

Run Charts

• Run Charts are representing change in measurement over a sequence or time

• Determining Cyclic Event• Gather Data• Organize Data

Control Charts

• Statistical tool, showing whether a process is in control or not• Taking samples of a process and detect possibility of process being out of

control• Define Upper limit, lower limit and medium value• Draw Chart.

Y

X

Upper limit

Lower limit

Average/Spec

Scatter Diagrams• Decide which paired factors you want to examine. • Both factors must be measurable on some incremental

linear scale. • Collect 30 to 100 paired data points. • Find the highest and lowest value for both variables.

• Draw the vertical (y) and horizontal (x) axes of a graph. • Plot the data

Y

X

Lean and Six Sigma concepts in Healthcare

• Hospitals using Lean and Six SigmaJames Levett, MD, is chairman : – American Society for Quality's healthcare division – Chief medical officer for The Physicians' Clinic of Iowa. – In this interview with Healthcare Finance News :

• Lean and Six Sigma business management strategies to reduce costs and improve productivity.

• Lean : Reduce processing time–Eliminate waste/Error• What Is 6?

• Metric for quality measurement • Method of continuous improvement • Enabler for cultural change

Quality System

• Quality System has become vital role for survive of an organization.

• International Organization for standards (ISO) technical team developed the quality system standards.– ISO 9001:2000 (Quality Management Systems)

• NABL – ISO 15189-2003

Benchmarking

• Benchmarking is defined as – Measuring of performance best in hospitals – Determining how the best in time achieve – Performance levels – The information of hospital’s

• Strategies • Planning• Implementation

Continuous Quality Improvement

• Part of the management of all system and process • Achieving the highest of performance • The process of continues improvement must contain

regular cycles of planning, execution and evolution

Proposed vision for India’s healthcare system

EVERYONE'S HAPPY!

CustomerOrganization

My Experience in TQM

• Learn the TQM during Industry experience: – Transasia Bio-Medicals Ltd, Mumbai– Inspired from Production team– Quality Integration team– Colleges and team my members

• Training Under the Japanees Quality Consultant– Mr. Yashiki San (43 years Experience in QMS in

Automobile Industry – TOYOTA and others)• In future I want to start Quality Management Consultants in

Healthcare Management for Hospital systems.

Reference:

• Bibliography– K.Shridhara Bhat, “Total quality management ”– R.P. Mohanty & R.R. Lakhe, “ TQM in service sectors”– James R. Evans and James W. Dean, “ TQM organization, and strategy”– R.S. Naagarazan and A.A.Arivalagar, “Total Quality Management”

• Webliography– www.ge.com– www.infoforhealth.org– www.asq.org

Question ???