total quality management in healthcare-chapter one

8/9/2019 Total Quality Management in Healthcare-chapter One

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TOTAL QUALITY MANAGEMENT IN HEALTHCARE

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CHAPTER ONE

TOTAL QUALITY MANAGEMENT

Total quality management (TQM) is a management philosophy that emphasizes on managing the

entire organization so that it excels in all dimensions of products and services that are important to

the customer. TQM, essence, is an organizationwide emphasis on quality as defined by the customer.

Under TQM, everyone from the CEO on down to the lowest-level must be involved. TQM can be

summarized by the following actions:

1. Find out what customers want. This might involve the use of surveys, focus groups,

interviews, or some other technique that integrates the customers voice in the decision-

making process

2. Design a product or service that will meet or exceed what customers want. Make it easy to

use and easy to produce.

3. Design a production process that facilitates doing the job right the first time. Determine

where mistakes are likely to occur, and try to prevent them. When mistake do occur, find why

so that they are less likely to occur again. Strive to mistake prove the process.

4. Keep track of results, and use those results to guide improvement in the system. Never stop

trying to improve.5. Extend these concepts to suppliers and to the distributors.

According to Kinicki and Williams (2008), TGM is defined as a comprehensive approach- led by to

management and supported throughout the organization- dedicated to continuous quality

improvement, training, and customer satisfactory.

There are four components to QTM:

1. Make continuous improvement a priority

2. Get every employee involved.

3. Listen to and learn from customers and employees

4. Use accurate standards to identify and eliminate problems

These may be summarized as two core principles of TQM- namely, (1) people orientation- everyone

involved with the organization should focus on delivering value to customers- and (2) improvement

orientation- everyone should work on continuously improving the work processes.

1. People orientation- focusing everyone on delivering customer value. Organizations adopting

TGM value people as their most important resource- both those who create a product or

service and those who receive it. Thus, not only are employees given more decision-making

power, so are suppliers and customers.

This people orientation operates under the following assumptions

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Delivering customer value is most important. The purpose of TQM is to focus people,

resources, and work processes to deliver products or services that create value for

customers.

People will focus on quality if given empowerment. TQM assumes that employees

and suppliers will concentrate on making quality improvement if given the decision

making power and to do so. Customers can also be valuable part of the process if theyare allowed to express choices.

TQM requires training, teamwork, and cross- functional efforts. Employees and

suppliers need to be well trained, and they must work as teams. Teamwork is

considered important because many quality management problems are spread across

functional areas. For example, if a car or cell phone design specialist conferred with

marketing specialists (as well as customers and suppliers), they will find the real

challenge of using a cell phone in a car is not talking on it but pushing 11 tiny buttons

to call a phone number while driving 65 miles an hour.

2. Improvement orientation- focusing everyone on continuously improving work processes.

Big schemes, grand designs, and crash programs capture many customer hearts. While these

approaches certainly have their place, the lesson of the quality movement from overseas is

that the way to success is through continuous small improvements. Continuous improvement

is defined as ongoing small, incremental improvement in all parts of an organization- all

products, services, functional areas, and work processes.

This improvement orientation has the following assumptions,

Its less expensive to do it right the first time. TQM assumes that its better to do

things right the first time than to do costly reworking. To be sure, there are many costs

involved in creating quality products and services- training, equipment, and tools, for

example. But they are less than the costs of dealing with poor quality- those stemming

from lost customers, junked materials, time spent reworking, and frequent inspection,for example.

Its better to do small improvements all the time. This is the assumption that

continuous improvement must be an every day matter, that no improvement is too

small, that there must be an ongoing effort to make things better a little bit at a time

all the time.

Accurate standards must be followed to eliminate small variations. TQM emphasizes

the collection of accurate data throughout every stage of the work process. It also

stresses the use of accurate standards (such as benchmarking), to evaluate progress

and eliminate small variations, which are the source of many quality defects.

There must be strong commitment from top management. Employees and suppliers

wont focus on making small incremental improvements unless managers go beyondlip service to support high-quality work.

QUALITY GURUS

EDWARDS DEMING. Placed great importance and responsibility on management, at both the

individual and company level, believing management to be responsible for 94% of quality problems.

His fourteen point plan is a complete philosophy of management that can be applied to small or large

organizations in the public, private or service sectors:

1. Create constancy of purpose towards improvement of product and service

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2. Adopt the new philosophy. We can no long live with commonly accepted levels of delay,

mistakes and defective workmanship

3. Cease dependence on mass inspection instead, require statistical evidence that quality is built

in

4. End the practice of a warding business on the basis of price

5. Find problems. It is managements job to work continually on the system6. Institute modern methods of training on the job

7. Institute modern methods of supervision of production workers. The responsibility of

foremen must be changed from numbers to quality

8. Drive out fear, so that everyone may work effectively for the company

9. Break down barriers between departments

10. Eliminate numerical goals, posters and slogans for the workforce asking for new levels of

productivity without providing methods

11. Eliminate work standards that prescribe numerical quotas

12. Remove barriers that stand between the hourly worker and their right to pride of

workmanship

13. Institute a vigorous programme of education and retraining14. Create a structure in top management that will push on the above points every day

He believed that adoption of, and action, the fourteen points was a signal that management intended

to stay in business. Deming also encouraged a systematic approach to problem solving and promoted

the widely known Plan, Do, Check, Act

ACT PLAN

CHECK DO

It is universal improvement methodology, the idea being to constantly improve, and thereby reduce

the difference the requirements of the customers and the performance of the process. The cycle is

about learning and on going improvement, learning what works and what does not in a systematic

way and the cycle is complete , another starts.

JOSEPH M JURAN

Juran developed quality trilogy- quality planning, quality control and quality improvement. Good

quality management requires quality actions to be planned out, improved and controlled. The process

achieve control at one level of quality performance, then plans are made to improve the performanceon a project by project basis, using tools and techniques such as pareto analysis. This activity

eventually achieves breakthrough to an improved level, which is again controlled, to prevent any

deterioration.

Quality Control Quality Planning

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(Breakthrough) (pareto analysis)

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Quality Improvement

(Project-by project)

Juran believed quality is associated with customer satisfaction and dissatisfaction with the product,

and emphasized the necessity for ongoing quality improvement through a succession of small

improvement projects carried out throughout the organization. His ten steps to quality improvementare:

1. Build awareness of the need and opportunity for improvement

2. Set goals for improvement

3. Organize to teach the goals

4. Provide training

5. Carry out projects to solve problems

6. Report progress

7. Give recognition

8. Communicate results

9. Keep score of improvements achieved

10. Maintain momentum

He concentrated not just on the end customer, but on other external and internal customers. Each

person along the chain, from product design to final user, is a supplier and a customer. In addition,

the person will be a process, carrying out some transformation or activity.

SUPPLIER PROCESS CUSTOMER

GENICHI TAGUCHI

Believed it is preferable to design product that is robust or insensitive to variation in the

manufacturing process, rather than attempt to control all the many variations during actual

manufacture. To put this idea into practice, he took the already established knowledge on

experimental design and made it more usable and practical for quality professionals. His message

was concerned with the routine optimization of product and process prior to manufacture rather than

quality through inspection. Quality and reliability are pushed back to design stage where they really

belong, and broke down off-line quality into three stages:

1. System design

2. Parameter design

3. Tolerance design

Taguchi methodology is fundamentally a prototyping method that enables the designer to identify

the optimal settings to product that can survive manufacturing time after time, piece after piece, andprovide what the customer wants. Today, companies see a close link between Tagichi methods,

which can be viewed along a continuum, and quality function deployment (QDF)

PHILIP B. CROSBY

Crosby is known for the concepts of quality is free and zero defects, and his quality improvement

process is based on his four absolutes of quality:

1. Quality is conformance to requirements

2. The system of quality is prevention

3. The performance standard is zero defects

4. The measurement of quality is the price of non-conformance

His fourteen steps to quality improvement are:

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Management is committed to a formalized quality policy

Form a management level quality improvement team (QIT) with responsibility fir

quality improvement process planning and administration

Determine where the current and potential quality problems lie

Evaluate the cost of quality and explain its use as a management tool to measure

waste

Raise quality awareness and personal concern for quality amongst all employees

Take corrective actions, using established formal systems to remove the root causes of

problems

Establish a zero defects committee and programme

Train all employees in quality improvement

Hold zero defects day to broadcast the change and as a management recommitment

and employee commitment

Encourage individuals and groups to set improvement goals

Give formal recognition to all participants

Establish quality control councils for quality management information sharing

Do it over again- form a new quality improvement team

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total quality management in healthcare-chapter one

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