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PubMed1993

Introduction of total quality management into a clinical chemistry laboratory.

Total quality management (TQM) was introduced into a clinical chemistry laboratory department. During the first 9 months, 35 quality improvement projects were introduced, involving 87% of the Department's staff. As a result of these projects and with a capped budget, a range of new clinical services was introduced, significant improvements in the speed of Departmental services was documented, productivity improvements were achieved, and a 10-fold reduction in staff resignations occurred. The major hindrance encountered was the lack of interest from other non-quality orientated departments elsewhere in the hospital.

Chemistry, Clinical↗
PubMed1994

Five years of total quality management: Campbelltown Hospital.

There are many articles in the health literature outlining either a framework for total quality management (TQM) or a success story. There is a dearth of literature reflecting the shortcomings of total quality management during implementation. Yet many of the world's most successful companies learn by reflecting about their past, for example, British Petroleum, IBM, Boeing, Xerox. This paper describes, from a general manager's perspective, the practical application of total quality management to a hospital setting over five years. The paper outlines the important ingredients to success and the shortcomings encountered along the way. Supporting literature is cited where appropriate. Strategies that were implemented contrary to common total quality management thinking are highlighted. The paper concludes with an outline of the four key lessons learnt over the five-year period.

Decision Making, Organizational↗
PubMed1995

Implementing total quality management in an academic surgery setting: lessons learned.

Total Quality Management, a philosophy developed by W. Edwards Deming, has been used successfully in many countries and in many types of organizations to improve the quality of processes. The system is based upon the scientific method and provides the ability to solve long-standing, recalcitrant problems. The application of the TQM philosophy to health care, although recommended by many medical economists, is still in its infancy. At our medical center, three departments (Surgery, Anesthesiology, and Operating Room Services) joined forces to implement TQM. Critical activities early in implementation included establishing a Steering Committee, training key employees, providing systems for communicating TQM activities, and developing the leadership, facilitator, and other resources needed to support teams. Two of our first teams studied very different processes (one in the Operating Room, the other in outpatient Surgery clinics), providing many useful insights regarding keys to successful application of the TQM philosophy. We have learned strategies for increasing acceptance of and participation in TQM efforts on the part of staff members and, in particular, physicians, and for initiating the cultural change needed for TQM. Although the teams have met with resistance to behavioral changes and a lack of full support from some upper-level administrators in the Medical Center and the Hospital, most of them have been quite successful in improving the processes under study. We conclude that, with the proper leadership and facilitation, the TQM philosophy can be successfully implemented in the health care environment. Total Quality Management (TQM) as a system for improving the quality of processes has been successful in many countries throughout the world for organizations offering a wide variety of products and services. This article will describe specific TQM endeavors, both successful and unsuccessful, undertaken in an academic surgery department in the United States. This description will illustrate the lessons we have learned in our attempt to change a complex organization and will enable readers to determine whether an analogy exists between our organization's response to problem solving and theirs.

Academic Medical Centers↗
PubMed1992

Implementing total quality management in the Spanish health care system.

A Total Quality Management Programme for the Spanish Health Care System was set in motion in 1986. The first phase of the programme covers three areas: (1) information sources, (2) training, (3) Total Quality activities, through a cascade of four coordinated projects. The first one defines a basic nucleus of patient information and established two national standards: (a) a minimum basic data set, (b) the use of an ICD-9-CM Spanish translation for codification of diagnoses and procedures. The second is an open demonstration project implementing these two standards in National Health Service hospitals and carrying out intensive training on ICD-9-CM codifiers. The third project encompasses two pilot studies on case-mix measurements systems and cost analysis framework. Through the fourth project concepts, methods and tools for Total Quality Management are developed, setting up specific working groups on clinical and organizational indicators for hospitals and primary health care.

Delivery of Health Care↗
PubMed1995

A physical examination of health care's readiness for a total quality management program: a case study.

Initiating a total quality management (TQM) effort can be a time-consuming and costly effort for a hospital. Perceptions of management and employees are important in initiating TQM because people function as if perceptions are fact. Assessing these perceptions and determining the levels of readiness or resistance to change are important steps in reducing costs, thus increasing organizational ability to address proactively challenges to the implementation and ultimate success of a TQM effort. Key assessment criteria are discussed including a comparison of management and employee perceptions in one hospital.

Efficiency, Organizational↗
PubMed1996

Total quality management and nursing: a shared vision.

The application of the Total Quality Management (TQM) philosophy within the health care sector would enhance the development of nursing power, leadership and knowledge. TQM challenges conventional management techniques as it requires a participative management style in order to be effective. There are many potential benefits for nurses, when quality assurance monitoring within a hierarchical management structure, is replaced with a focus on continuous quality improvement by every member of staff. These benefits are described within the context of both organisational and personal commitment to Total Quality Management.

Decision Making, Organizational↗
PubMed1995

Total quality management as a health care corporate strategy.

Total quality management (TQM) must become a part of corporate strategy if it is to become a way of life in health care. TQM should be understood in the context of a cultural transformation. The greatest challenge for top management is to create an organization in which every employee, department and function is linked inextricably to the organization's mission and vision. One of the key benefits of TQM is the use of teams to work on and achieve organizational objectives. Health care managers must understand motivation in order to carry the workforce with them to attain those objectives.

Hospital Administration↗
PubMedDate not supplied

Applying total quality management concepts to public health organizations.

Total quality management (TQM) is a participative, systematic approach to planning and implementing a continuous organizational improvement process. Its approach is focused on satisfying customers' expectations, identifying problems, building commitment, and promoting open decision-making among workers. TQM applies analytical tools, such as flow and statistical charts and check sheets, to gather data about activities within an organization. TQM uses process techniques, such as nominal groups, brainstorming, and consensus forming to facilitate communication and decision making. TQM applications in the public sector and particularly in public health agencies have been limited. The process of integrating TQM into public health agencies complements and enhances the Model Standards Program and assessment methodologies, such as the Assessment Protocol for Excellence in Public Health (APEX-PH), which are mechanisms for establishing strategic directions for public health. The authors examine the potential for using TQM as a method to achieve and exceed standards quickly and efficiently. They discuss the relationship of performance standards and assessment methodologies with TQM and provide guidelines for achieving the full potential of TQM in public health organizations. The guidelines include redefining the role of management, defining a common corporate culture, refining the role of citizen oversight functions, and setting realistic estimates of the time needed to complete a task or project.

Humans↗
PubMed1995

Total quality management of a medical residency.

Although many hospitals have begun the long and difficult process of adapting to the concepts of total quality management, few have reported efforts to apply total quality management to a medical residency. We report here the initial results of the Western Pennsylvania Hospital's efforts, as part of the hospital's conversion of its management structure to total quality management.

Educational Measurement↗
PubMed2000

Clinical nutrition and foodservice personnel in teaching hospitals have different perceptions of total quality management performance.

OBJECTIVE: To investigate the perceived total quality management (TQM) performance of their department by clinical nutrition managers and dietitians, and foodservice managers and supervisors, in hospital food and nutrition service departments. DESIGN: Using a 2-part questionnaire containing items about 3 constructs of TQM performance and demographic characteristics, participants rated their perceptions of TQM performance. SUBJECTS: Employees in 7 Council of Teaching Hospitals. Of the 128 possible respondents, 73 (57%) completed the study. STATISTICAL ANALYSES PERFORMED: Correlation analysis to identify relationships between demographic characteristics and TQM performance. Analysis of variance to investigate statistical differences among hospitals and between subject groups and types of employment positions. RESULTS: Three TQM constructs--organization, information, and quality management--were evaluated. The clinical nutrition manager and dietitian group had mean ratings between 3.1 and 4.7 (5-point Likert scale); the foodservice manager and supervisor group had mean ratings from 2.7 to 4.0. Education level was significantly correlated (r = 0.44) to performance of employee training in the clinical nutrition group. The number of employees directly supervised was negatively correlated (r = -0.21) to the performance of employee training in the foodservice group. APPLICATIONS: As the dynamic roles of dietitians change, many dietitians will occupy management positions in organizations such as restaurants, health food stores, food processing/distribution companies, and schools. This study demonstrates how a TQM survey instrument could be applied to clinical nutrition and foodservice settings. Dietitians will need to assess TQM in their workplace facilities, especially because of the direct links of TQM to productivity and client satisfaction.

Adult↗
PubMed1998

Total quality management in behavioral health care.

The literature on total quality management or continuous quality improvement in the behavioral health care field is just beginning to emerge. Although most of the evidence on its effectiveness remains anecdotal, it seems clear that it can work in behavioral health care organizations with strong leadership support and a long-term commitment.

Humans↗
PubMed1994

Expediting the turnaround of radiology reports: use of total quality management to facilitate radiologists' report signing.

OBJECTIVE: The purpose of this study was to determine whether total quality management techniques could be used to speed radiologists' performance on the task of signing reports. SUBJECTS AND METHODS: Total quality management represents a group of tools that can be used to improve the functioning of complex processes in the workplace. The steps involved in our total quality management project were as follows: (1) commit to improving radiologists' performance, (2) commission an interdisciplinary study team, (3) propose hypotheses for the causes of signing delays, (4) identify the key issues constraining performance (Pareto analysis), (5) intervene to correct systematic problems in a test system, (6) evaluate the results of intervention on radiologists' report signing performance, and (7) hold the gains achieved by the intervention. An interdisciplinary study team identified five key obstacles to prompt signing of reports: (1) radiologists' absence from the department when reports were available for signing (e.g., nights and weekends), (2) dysfunctional hand-off between transcriptionist and radiologist, (3) requirement that a fellow or resident sign before a staff radiologist, (4) lack of a system for signing by proxy (if primary radiologist is away), (5) perceived lack of impact of signed report on clinical decision making. RESULTS: Interventions included (1) providing home computer terminals, (2) implementing a buddy system for proxy signing, (3) eliminating the requirement for a signature from a fellow or resident, (4) teaming groups of radiologists with specific transcriptionists, and (5) streamlining transcription service. When these enhancements were used in a test system, the mean time required to sign reports decreased 59% from 26.0 +/- 8.4 hr (mean +/- standard error) in the baseline period to 10.6 +/- 2.9 hr (in the enhanced period, p = .05). CONCLUSION: We conclude that total quality management methods can accelerate radiologists' signing of reports.

Authorship↗
PubMed1995

Booking processes for minor procedures in a fifteen bed rural hospital: a total quality management project.

The pressure to improve the quality of clinical and customer service outcomes and the challenge to design work processes that predictably lead to satisfying and cost-effective results, was incentive enough for management to implement Total Quality Management and Continuous Quality Improvement projects in this 15 bed rural hospital. Patients arriving unannounced at the hospital for minor procedures were identified as a problem by the nursing staff. Data were collected and a team set up to look at ways to streamline this process.

Appointments and Schedules↗
PubMed1996

Total quality management in hospitals: the contributions of commitment, quality councils, teams, budgets, and training to perceived improvement at Veterans Health Administration hospitals.

Studies of total quality management as a means of improving health care quality to date have relied on case studies of individual teams or hospitals. The Total Quality Improvement Registry Project surveyed quality coordinators (n = 36) and quality improvement team leaders (n = 228) to collect both site-level and team-level data on quality improvement in Veterans Health Administration hospitals. Usable responses were received from 100% of quality coordinators and 73.7% (168) of team leaders. Site-level data include hospital structural characteristics and measures of training and commitment, as well as features and activities of the hospital quality councils. Team-level data include size, membership, task, age, activities, and a proxy measure of quality improvement. The authors report on the relations between levels of commitment to total quality management principles, training levels, activities of quality councils, and team formation and success. These data provide support for a model of commitment to quality improvement that involves four realms of influence within the medical centers: (1) management, (2) physician leadership, (3) physician staff and middle management, and (4) nurses and employees. The authors also report on the activities of quality councils and the relation of their activities to commitment and perceived improvement. Using bivariate correlation and multiple regression, the authors found that the age of the quality council, overall facility commitment to total quality management philosophy, and physician commitment are the most critical variables in explaining numbers of teams, training intensity, and total perceived improvement at this sample of medical centers. Specifically, we find that commitment to total quality management philosophy and the number of active teams explains 41% of the observed variation in quality improvement. In future articles, the authors will report details of team activities and the development of teams over time.

Budgets↗
PubMed1995

The implementation of total quality management in hospitals: how good is the fit?

Total quality management has become popular among hospitals because of its promise to reconcile trade-offs between cost and quality. However, assumptions inherent in TQM may not translate to the hospital environment: hierarchical management control over the technical core and the dominance of rational decision making. This article considers these two assumptions and suggests that the application of TQM to hospitals take them into account because they may compromise its success.

Health Services Research↗
PubMedDate not supplied

Implementing total quality management in healthcare: how do we get there from here?

Total quality management (TQM), with its long and proven record of success in manufacturing and other service industries, is relatively new to the healthcare field. But given the success of TQM in pioneering healthcare organizations, many more organizations will implement it in the coming years. TQM provides the most promising hope for improving the nation's healthcare quality while controlling costs. This change will have its advantages, but will not be without pitfalls and problems. That is why there are specific steps that must be taken to make TQM a success.

Hospital Administration↗
PubMed1991

Total quality management and the Army health care system.

Total quality management (TQM) is the newest in a long line of magic formulas which have been touted as saviors for American industry and medicine. The author discusses the basic concepts of TQM and notes that much of it resembles philosophical beliefs long held by the medical community. TQM does offer many opportunities to refine old concepts and further those goals of quality care to which health care providers have always aspired. If, however, it becomes simply another codified bureaucracy, then a great deal of time and money will be invested for very little gain.

Military Medicine↗
PubMed1993

Implementing total quality management: the role of the medical staff.

The American health care industry is currently in the process of adopting total quality management--a comprehensive, participative, and systematic approach to planning and implementing continuous quality improvement. Since all hospitals will soon be required to establish total quality management programs, physicians need to understand and adapt to this approach. This article describes the total quality management process for identifying and resolving problems in the health care system and the role of the medical staff in ensuring the success of that process.

Hospitals↗