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PubMed1994

A journey into TQM (total quality management).

Total quality management (TQM) which has been implemented for some time in industry and more recently in hospitals is just beginning to come to long term care organizations. Directors of Nursing can prepare themselves for such a program in their facility by learning from the experience of long term care facilities that have implemented TQM. This is part one of a two part series which describes the implementation process used and a discussion of problems encountered. The second article which will appear in a later issue describes the experience and findings of one project team-the nursing documentation team.

Humans↗

PubMedDate not supplied

Introducing total quality management.

Total quality management is a system that could pay dividends for National Health Service managers and employees but would require a change of culture, from one of crisis response to problems to one preventing them from happening in the first place. This article introduces the concept and describes the preconditions for its successful application.

Health Personnel↗

PubMed1993

The role of governing boards of trustees in promoting total quality management.

As total quality management becomes more accepted in health care organizations, it is apparent that organization-wide efforts will be needed to reinforce and institutionalize these changes. This article stresses the importance of the direct involvement of the board of trustees in setting the climate for successful interventions. The board must be open to using its influence on the system to facilitate changes. In addition, the board must be a part of the total quality management process. This article concludes with 10 guidelines for the implementation of TQM, each designed to help ensure positive outcomes.

Governing Board↗

PubMed1993

System for quality management.

Total quality management will provide important benefits for organizations that are involved with the delivery of occupational and environmental health care. These organizations should shift from traditional medical management to the new paradigm. Identification of a set of relevant parameters for this new management system is necessary to implement the quality culture within our professional settings. An exhaustive literature search was undertaken on the topic of total quality management to delineate a framework for consideration by occupational and environmental health managers. Proposed are essential components of a management system for quality excellence which are derived from review of reported approaches among health care organizations and industry, various lists of quality principles and criteria, and classical systems theory.

Delivery of Health Care↗

PubMed1993

Evolution of hospital industrial engineering: from scientific management to total quality management.

Industrial engineering applications in the hospital industry first began in 1910. This paper traces the evolution of hospital industrial engineering in five distinct phases. For each of the major phases, this paper presents the contributions made by industrial engineers. Many of the techniques advocated by industrial engineers are now being taught to hospital employees as hospitals introduce total quality management (TQM) within the health-care industry. TQM introduction has meant a new role for industrial engineers, as that of a teacher, coach, and a facilitator. This new role holds much promise for the improvement of quality and productivity in health care.

Efficiency, Organizational↗

PubMed1995

Total quality management: field of dreams?

Total quality management promises to reconcile cost/quality conflicts, increase customer satisfaction, and improve hospitals' competitiveness as well as operational and financial performance. This article reviews the hospital literature on TQM and concludes that there is little evidence to substantiate these claims. The article concludes with implications for research and management.

Economic Competition↗

PubMed1992

Total quality management within the NHS.

Total quality management is a system which enables managers to analyse and develop their services within a common framework. It incorporates the needs and preferences of service users in the setting and improvement of quality standards, within resource constraints.

Humans↗

PubMed1993

Total quality management: doing things right.

Total quality management transforms quality assurance performance controls into a dynamic system for continuously improving healthcare services to internal and external "customers" in terms of outcomes. Success depends upon gaining and maintaining commitment of physicians, top management and key staff members through a working environment which values and rewards improvement efforts.

Management Quality Circles↗

PubMedDate not supplied

Total quality management in cytology.

The total quality management (TQM) process was incorporated into the operation of the Cytology Department, Wisconsin State Laboratory of Hygiene, in January 1991. TQM was successful in identifying inefficiencies in laboratory practices and in developing mechanisms for improvement in laboratory operation. Within four months the turnaround time was reduced from 71 to 15 days. Participatory management also resulted in marked improvements in all facets of departmental operation. Since the Clinical Laboratory Improvement Act of 1988 mandates a system to respond to problems arising between the laboratory and individuals who order tests, many cytology laboratories will undoubtedly turn to TQM to manage their operations in a customer-oriented fashion. For hospital-based laboratories, Joint Commission on Accreditation of Healthcare Organizations rules will also require a customer focus. Cytologists desiring to embark on TQM can learn more about the system from books, journal articles and seminars.

Cell Biology↗

PubMed1996

Managed care and total quality management: a necessary integration.

The process of quality improvement/total quality management (QI/TQM) plays a key role in the delivery of health care in a managed care system. The concepts and ideas surrounding QI/TQM and managed care are interrelated, and the success of health care delivery depends on the integration and coexistence of these two philosophies. In looking more closely at these concepts, it becomes clear that the principles of QI/TQM must underlie strategic decisions involved in the implementation of a managed care system. Nurses play a key role in the success of this integration as nurse case managers, nurse practitioners, and nurse administrators. They have a direct impact on the many variables and goals of both QI/TQM and managed care.

Case Management↗

PubMed1992

Total quality management in American industry.

The definition of total quality management is conformance to customer requirements and specifications, fitness for use, buyer satisfaction, and value at an affordable price. The three individuals who have developed the total quality management concepts in the United States are W.E. Deming, J.M. Juran, and Philip Crosby. The universal principles of total quality management are (a) a customer focus, (b) management commitment, (c) training, (d) process capability and control, and (e) measurement through quality improvement tools. Results from the National Demonstration Project on Quality Improvement in Health Care showed the principles of total quality management could be applied to healthcare.

Humans↗

PubMed1993

Total quality management and quality assurance: discussing the differences.

Total Quality Management and Continuous Quality Improvement have become the "buzz" phrase for the 1990s. Everyone seems to be jumping on the band wagon. But what is it, and is it right for your organization? We believe that Total Quality Management is superior to many Quality Assurance programs currently in use. There are, however, many considerations to take into account before implementing a Total Quality Management program. The purpose of this article is to explain the pros and cons of Total Quality Management and standard Quality Assurance programs and to compare and contrast these two approaches. This article focuses on barriers to successful implementation and presents several questions organizations can utilize in assessing readiness for a quality management program.

Humans↗

PubMedDate not supplied

The implementation of theory-based nursing practice: laying the groundwork for total quality management within a nursing department.

Total Quality Management (TQM) is a management philosophy that has had great success in increasing quality and productivity in the private sector. Health care executives are interested in adapting this approach to a health care environment. This article discusses the implementation of theory based nursing practice as one initiative that lays the groundwork for the successful utilization of TQM in a nursing department. The barriers to quality are usually processes not people. Implementation of Jean Watson's nursing theory emphasizes that nurses are co-participants in the processes of health care which results in better outcomes. Nurses are viewed as knowledge workers. Treating them as such, removes barriers to pride of workmanship and renews their commitment to the pursuit of excellence in their care.

Aged↗

PubMed1994

Total quality management approach improves medication replacement.

Total quality management (TQM) is based on understanding customer needs, improving key processes that affect customer satisfaction, and creating cross-functional teams to resolve process problems. This article describes application of TQM principles and problem-solving processes to improve one OR's medication exchange system. The problem was excessive monthly pharmacy medication replacement costs. The goal was to reduce the monthly medication replacement costs by 50%. Within four months, monthly medication replacement charges decreased from $656 to $302, and by one year, monthly charges decreased to $160. The new process had fewer steps, fewer staff members involved, and fewer delays in medication replacement.

Costs and Cost Analysis↗

PubMed1991

Total quality management. Applications to nursing service.

Total quality management (TQM) can offer nursing practical solutions to the "best for less" dilemma when specifically adapted to the needs of the nursing profession and individual nursing service departments. The author explains the TQM philosophy and its principles, presents strategies that may be used by nurse executives interested in integrating TQM into their nursing management systems, and discusses specific guidelines for successful implementation of TQM within any nursing department.

Career Mobility↗

PubMed1992

Is your organization ready for total quality management?

The evolution to a Total Quality Management (TQM) or Continuous Quality Improvement (CQI) philosophy is particularly attractive in the health care industry in its search for better ways of doing business to ensure financial survival in the current competitive environment. This article, however, suggests that some organizations may not benefit from attempting to implement methodology to achieve the widely accepted financial and operational benefits, not because of any weakness in the conceptual framework, but because of the culture and/or lack of dedicated resources required to ensure the acceptance and success of the approach. As a result, many providers are discovering that after a few years of implementation, benefits to the organization are not being recognized to the extent possible. Specific issues that have been identified as essential requirements to a successful implementation process or evolution to a continuous improvement culture are described in this article.

Health Personnel↗

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↗

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↗