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PubMed2002

Total quality management and the silent patient.

This essay examines the impact of the imposition of businesses techniques, in particular, those associated with Total Quality Management, on the relationships of important components of the health care delivery system, including payers, managed care organizations, institutional and individual providers, enrollees, and patients. It examines structural anomalies within the delivery system and concludes that the use of Total Quality Management techniques within the health care system cannot prevent the shift of attention of other components away from the enrollee and the patient, and may even contribute to it. It speculates that the organization ethics process may serve as a quality control mechanism to prevent this shift and so help eliminate some of the ethically problematic processes and outcomes within the health care delivery system.

Delivery of Health Care↗
PubMed1997

Changing clinicians' behaviors in an academic medical center: does institutional commitment to total quality management matter?

The purpose of this project was to determine whether changing clinicians' behaviors to reduce costs in a large academic medical center is facilitated by the prior existence of a total quality management program. Ten teams, made up primarily of clinicians, were charged with devising strategies for altering specific clinical behaviors to reduce costs without detriment to quality of care. Half the teams followed the center's total quality management approach. Team success was assessed by how well three key tasks were completed: problem definition, design of plan of action, and plan implementation. Two teams achieved outright successes, three had outright failures, and five were in between. Adherence to a total quality management approach was not found to be associated with team success. A much better predictor of success was the level of involvement and support by clinicians and managers; because that factor is largely controlled by institutional incentives, those incentives may need to be realigned before the effectiveness of a total quality management approach can be properly evaluated.

Academic Medical Centers↗
PubMed1993

Total quality management: rhetoric and reality.

TQM in health care today is still more rhetoric than reality. Changing the typical health care organization's culture and installing the infrastructure needed to support TQM will be expensive and time consuming, and will require a new technology of health care quality control that is still developing. TQM will achieve its considerable potential only if management stays the course, invests the time and money--and reins in Ruby and her ilk.

Cardiology Service, Hospital↗
PubMed1994

Total quality management in action: pharmacy system changes to decrease medication incidents and increase clinical services.

During a monitoring of risk management indicators (incident report analysis), a trend of increasing medication incidents was noted from 1987 to 1990. The medication ordering process was tracked using a flow chart, and, using an interdisciplinary team, the transcription system was targeted for corrective action. A "roving pharmacist" system was devised, with a resultant 63% decrease in the reported medication incident rate from 1990 to 1993.

Hospital Bed Capacity, 300 to 499↗
PubMed2005

Ergonomics in total quality management: how can we sell ergonomics to management?

The objective of this paper is to describe how and why ergonomics should be promoted in total quality management (TQM). Ergonomics and TQM activities are compared. An approach is proposed to apply ergonomics in TQM using ergonomics circles. An eight-step approach is introduced for applying ergonomics using ergonomics circles and a study that employed this approach in Korea is discussed. In applying this approach, all processes were first evaluated by workers. Processes that were identified as problematic were analysed by a company-wide committee to set priorities for improvement. An ergonomics improvement team consisting of safety and health personnel, process engineers and management innovation personnel then worked on the processes using a low-cost approach. It was found that applying ergonomics using ergonomics circles as quality circles in TQM was effective in improving workplaces and resulted in increasing productivity, cost saving and improved safety.

Efficiency↗
PubMed1995

How to achieve comprehensive teamwork in your pediatric dental office through total quality management (TQM).

Teamwork is considered the key to success in any organization. Total Quality Management (TQM) is a systematic process that optimizes quality and copes with change. The process includes customer satisfaction, as the ultimate criterion of quality; worker empowerment; and reliance on statistical process, rather than inspection and continuous improvement. Managers not only adopt new techniques but also a new philosophy, rethinking their roles to become leaders and mentors instead of bosses. Fourteen points, developed during several decades, are considered the cornerstone of quality and teamwork, and they can apply to what we do in the pediatric dental office. Together, these principles should be viewed as an ongoing process that can take up to five years or more and should be managed with the same emphasis as other systems in your office. The dentist, or leader, implements and takes part in the process, which will improve morale by increasing team spirit.

Humans↗
PubMed1997

Total quality management in accredited New South Wales hospitals: a public/private comparison.

Analysis of data collected in a 1994-95 survey of accredited New South Wales hospitals examined the adoption of key elements of total quality management practice in the public and private sectors. In a number of areas of practice widely considered to be central to a hospital's total quality management efforts, there was no statistically significant difference between the two sectors. Where differences existed, total quality management practices more likely to be adopted by public hospitals were limited in their scope and likely to be explained by structural peculiarities. In contrast, private hospitals were more likely to adopt practices more critical to the successful implementation of total quality management.

Accreditation↗
PubMed1997

A review of health interpreter services in a rural community: a total quality management approach.

The current focus in health care is on total quality management (TQM), a process that involves ongoing quality improvement and benefits both internal and external customers. In order to comply with the values of TQM, the Griffith Murrumbidgee Health Service set up a team to review the use of interpreters in a healthcare setting. Staff from a number of wards/units filled out a survey sheet regarding interpreter services for each patient/client presenting for service during a 1-month period. The results showed that (i) there was a marked tendency by staff to use non-accredited interpreters; and (ii) staff who used non-accredited interpreters tended to inappropriately assess patient/client interpreting needs and to be unfamiliar with the Health Care Interpreter Policy. The TQM team subsequently devised several strategies for change.

Accreditation↗
PubMed1998

Mental health and general practice: improving linkages using a total quality management approach.

This paper reports on a project to implement total quality management strategies to improve the linkages between general practitioners and specialist mental health services. The project implemented a process of change and objectively assessed the success of the process. The project involved all mental health staff (n = 100) in the St George Division of Psychiatry and Mental Health. General practitioners registered with the St George Division of General Practice were invited to participate in the change process. The project showed that the attempts to engage general practitioners in the ongoing care of patients with chronic mental illness is unlikely to be successful until mental health services promote general practitioner linkages as an ongoing service goal, relevant at all levels of delivery.

Advertising↗
PubMed1995

Use of total quality management techniques to improve compliance with a medication use indicator.

Total quality management techniques were used to lay the groundwork for and to implement procedural changes designed to improve compliance with the Joint Commission on Accreditation of Healthcare Organizations' medication use indicator for ordering and administering presurgical antibiotics. The effect of these procedural changes on patient outcomes (i.e., postsurgical infection rates and length of hospitalization) is described. In a study to assess compliance, 57 (30 percent) of 40 control patients received a presurgical antibiotic within 1 hour of incision compared with 65 (52 percent) of 126 study group patients, and 83 (44 percent) of the control group received a presurgical antibiotic within 2 hours of incision compared with 88 (70 percent) of 126 study group patients. Postsurgical infection rates and length of hospitalization were not significantly different (p = .407 and p = .885, respectively).

Anti-Bacterial Agents↗
PubMedDate not supplied

Statistical analysis of data in cervical cytology from the viewpoint of total quality management.

As a consequence of widespread dissatisfaction with the high incidence of false negatives in cytologic smear screening, the Clinical Laboratory Improvement Amendments of 1988 were enacted by Congress with specific requirements for quality assurance in the screening of cytologic smears for cervical cancer. This paper examines the process of cervical cytologic screening from a total quality management perspective and suggests the use of several statistical techniques from industrial total quality management for describing and monitoring the process of cytologic smear screening. Several examples are included, and a general approach to implementing these techniques is suggested.

Analysis of Variance↗
PubMed1995

Application of total quality management to mental health: a benchmark case study.

The search for models or "benchmarks" that reflect the successful application of total quality management (TQM) to the mental health field is one that goes largely unrewarded. This article describes a case study of one comprehensive mental health center that has made a serious commitment to the philosophy and principles of TQM and that is reaping significant benefits from that effort.

Community Mental Health Centers↗
PubMed1990

Total quality management in health: making it work.

Many health organizations are trying total quality management (TQM). This approach represents a total paradigm shift in health care management and presents a series of potential conflict areas in the way health organizations are managed. These areas include TQM's participatory approach versus professional and managerial authority, collective versus individual responsibility, quality assurance and standards versus continuous improvement, and flexible versus rigid objectives and plans. This article reviews the areas of conflict and suggests a number of action guidelines for the successful implementation of TQM.

Hospital Administration↗
PubMed1996

Total quality management practices in the NSW hospital system--an overview.

A two-phase descriptive study involving a questionnaire survey was undertaken during 1994 and 1995 to evaluate the extent of implementation of total quality management practices in New South Wales hospitals accredited by the Australian Council on Healthcare Standards. A survey response rate of 72 per cent was attained. Results indicated that most hospitals were aware of and consciously implemented aspects of the total quality management philosophy in some way. There is little evidence that whole systems have embraced the total quality management approach as a fully integrated endeavour.

Community-Institutional Relations↗
PubMed1993

Spreading the "good news" of total quality management: faith, conversion, and commitment.

In many ways the spread of total quality management (TQM) across this country can be compared to a religious conversion. Both cases are characterized by a philosophical shift with far-reaching changes in responsibilities and incentives for the people involved. This article bridges the disciplines of theology and health services management by elaborating a metaphor in which TQM is compared to various aspects of the Judeo-Christian faiths, such as the role of laws and standards; the importance of miracles, prophets, and evangelists; and the practical applications of living out the faith.

Christianity↗
PubMed1994

The Middle East total quality management conference.

The Middle East conference on the implementation of the total quality management (TQM) system in medical centers took place November 30 to December 2, 1993, in Jerusalem. The conference was designed to assist health care providers in their efforts to improve efficiency and effectiveness. It was also an opportunity for professionals from the area to meet and exchange ideas with the intention of creating a forum for continued cooperation.

Congresses as Topic↗
PubMed2002

Does the implementation of responsibility centers, total quality management, and physician fee programs improve hospital efficiency? Evidence from Taiwan hospitals.

OBJECTIVES: This study evaluates whether the implementation of various types of hospital-physician integration strategies, such as the responsibility centers system, total quality management, and physician fee programs, enhance efficiency for Taiwan hospitals. Because hospitals in Taiwan are structurally similar to staff-model HMOs, the study has implications beyond Taiwan. RESEARCH DESIGN: The Data Envelopment Analysis model is applied to measure hospital efficiency. Hospital efficiency refers to the ability to produce more outputs (eg, ambulatory and emergency visits, inpatient days, and inpatient visits) with the same inputs (eg, physicians, nurses, ancillary labor, and hospital beds). The sample consists of 90 general hospitals in Taiwan from 1994 to 1996. In addition, multitobit regression analysis is used to simultaneously estimate the effects of the hospital-physician integration strategies and provide better control for the effect of other factors (eg, size, degree of competition, ownership structure, teaching status, and the change in regulatory regime) that may also affect hospital efficiency. RESULTS: When evaluating the hospital-physician integration strategies individually, hospitals that implemented the responsibility centers system, total quality management, and physician fee programs were more efficient than hospitals that did not. Controlling for other factors using the multitobit model, hospitals that implemented physician fee programs remained significantly more efficient than others. In addition, hospitals that implemented total quality management were more efficient when they had implemented the strategy for at least 2 years. Hospitals that implemented the responsibility centers system were more efficient but only when integrating the system with formal incentive schemes. CONCLUSIONS: Physician fee programs seem to provide the most direct and robust incentives to enhance hospital efficiency under a fee-for-service regime like that in Taiwan. Because of time-lagged effects, hospitals that implemented the total quality management programs were more efficient but only when the programs had been implemented for at least 2 years. The responsibility centers system can also be effective when the system was associated with formal incentive schemes. The results indicate the importance of having both the individual-based and team-based incentives in place. Finally, the hospital-physician integration strategies appear to be effective individually, but the results change significantly when they are evaluated simultaneously, together with other control variables, in the tobit model. This indicates the importance of investigating hospital-physician integration strategies as a portfolio instead of a single tool.

Decision Making, Organizational↗