Quality Management in Healthcare Project

Quality Management in Healthcare Project

According to Koskela et al. (2019), quality occurs when a product or service fulfils the demands of the consumer. Quality in the healthcare setup occurs when healthcare services improve patient outcomes and are harmonious with evidence-based practice (Seelbach & Brannan, 2022). Quality management involves the application of resources to improve patient safety and achieve better outcomes (Seelbach & Brannan, 2022). Examples of these resources include pertinent policies, standard operating procedures, and system designs. This paper describes quality management in a healthcare facility with a Total Quality Management program.

The Healthcare Facility

The healthcare facility serves both outpatient and inpatients; the inpatient section has a bed capacity of 1000. The hospital serves approximately 900 patients per day. In addition, it has various clinical, supportive, technical, and administrative departments. Examples of clinical departments are the emergency department, outpatient, inpatient, gynecology and obstetrics, pediatrics, orthopedics, urology, and hematology. Further, supportive departments include radiology, pharmacy, and the nutrition department. At the same time, the technical departments include the engineering and information technology departments. Administrative departments include the human resource, finance, and medical record sections. Accordingly, each department is headed by a director or manager in charge of the routine operation.

I interviewed the healthcare facility’s quality manager. During our interaction, I learned that their priority is the delivery of quality healthcare services. To achieve this, the hospital has embraced holistic care and patient-centeredness. Additionally, its policies advocate for research, continuous professional education, and evidence-based practice. According to the quality manager, their policies have helped them create a culture of interdisciplinary collaboration in their day-to-day activities. By so doing, the productivity of healthcare practitioners and other key stakeholders has increased significantly. This is evidenced by the performance of their benchmark metrics. For example, their recent quarterly and annual reports from the National Database of Nursing Quality Indicators reveal a good performance of their quality indicator metrics.

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Members of the Total Quality Management Committee

The healthcare facility uses the Total Quality Management (TQM) Model. The TQM model entails the integration of all resources and employees in a perpetual and collaborative effort to improve productivity and the quality of care, minimize care costs and avail quality patient (customer) centred services (Alzoubi et al., 2019). The healthcare facility’s Total Quality Management committee consists of twenty-three members. The quality manager and twenty-two members from each department. Each of the twenty-two members is selected by employees in their respective departments. By so doing, the committee is a representative of all employees and promotes employee participation. The members of the committee are responsible for the allocation of resources, planning, employee training, and coordinating activities to achieve established goals and objectives.

The members of the committee are appropriate in number and composition. Each member of the committee is a representative from the health care facility’s department. These representatives update employees regularly on the proceedings of the committee. This entails employee training and availing necessary resources as allocated by the committee. Accordingly, the committee fulfils the provision of Total Quality Management that champions the integration of employees, resources, and systems to improve the quality of services, minimize treatment costs and provide patient-centred services (Alzoubi et al., 2019).

Methodology Utilized to Address Concerns and Issues

The TQM committee is guided by principles of Total Quality Management, Deming’s points for TQM, and Deming’s plan-do-study-act (PDSA) cycle. This approach has been a success for the committee and the healthcare facility, evidenced by the performance of their quality benchmark metrics.

Principles of Total Quality Management

The Total Quality Management Committee embraces a customer-focused approach. In this context, patients are the customers. This approach considers patients as the primary determinants of quality (Permana et al., 2021). The committee conducts periodic surveys to identify and understand patients’ needs, perceptions, and expectations. This feedback is used to modify the goals, objectives, and policies of the healthcare facility. The focus is to establish policies, goals, and procedures that are in harmony with the needs of the patients (Alzoubi et al., 2019). After that, these modifications are implemented by all stakeholders and employees of the healthcare facility. Implementation is succeeded evaluation of patient’s levels of satisfaction. The process is continuous, and each phase improves the preceding provisions based on employees’ feedback (Alzoubi et al., 2019). According to the quality manager, this approach requires establishing a balance for fulfilling the needs of patients and other stakeholders such as employees and the hospital management.

Total employee involvement is the other principle embraced by the committee. Each member of the committee ensures that the vision, goals, and objectives are conveyed to employees (Alzoubi et al., 2019). Additionally, comprehensive routine training of employees creates a knowledgeable and competent task force that works towards the established goals (Alzoubi et al., 2019). Allocation of pertinent resources eliminates unnecessary competition and promotes total employee commitment. In addition, open communication and a clear definition of roles avoid confusion, whereas self-evaluation enables employees to participate actively in assessing the achievement of personal goals (Alzoubi et al., 2019). A collectivistic workplace culture creates a workforce that strives toward accomplishing group goals and promotes collaboration (Permana et al., 2021). By so doing, total employee involvement is met.

The third principle is process-centeredness. This approach requires the committee to embrace the right steps to create consistency in the productivity of employees and the quality of services. The committee uses various tools to accomplish this. Process flowcharts are used to create a clear chain of command and assign tasks to each employee (Seelbach & Brannan, 2022). Visual action plans enable all employees to evaluate the group’s progress, pending tasks, and how to execute specific tasks (Seelbach & Brannan, 2022). The committee conducts periodic analyses of the employee’s activities to determine the need for improvement or identify any shortcomings.

The TQM committee also focuses on establishing an integrated system. This is accomplished by interconnecting the processes of all departments in the healthcare facility (Seelbach & Brannan, 2022). Employees in all departments are required to have an in-depth understanding of the organization’s standard operating procedures, policies, goals, and objectives (Seelbach & Brannan, 2022). Routine training and continuous educational sessions help to achieve an integrated system. Visual charts and flowcharts help eliminate confusion and role ambiguity in organizational standard operating procedures, policies, goals, and objectives (Babu & Thomas, 2020). An integrated system emphasizes quality services that fulfil patients’ expectations and needs (Seelbach & Brannan, 2022).

A strategic and systematic approach is the other principle embraced by the TQM committee. This involves the management of the interconnected process that improves organizational efficiency in the fulfilment of its goals (Nguyen & Nagase, 2019). Essentially, employee training, appropriate allocation of adequate resources, and perpetual evaluation are enablers of strategic and systematic approaches (Seelbach & Brannan, 2022). Accordingly, this approach facilitates the timely identification of shortcomings and prompt initiation of corrective measures. Consequently, timely interventions improve employee performance and increase the quality of patient-centred services (Aggarwal et al., 2019).

Moreover, continual process improvement enables the TQM committee to identify shortcomings, address them and optimize the quality of healthcare services. Analytical and creative thinking skills and techniques facilitate continuous process improvement (Aggarwal et al., 2019). The committee advocates for research and innovation among employees to establish better approaches to service delivery. Furthermore, policies that improve the quality of healthcare services, health products, and patient outcomes are embraced (Aggarwal et al., 2019). Employees’ continuous professional education and higher education training equips them with knowledge and skills to facilitate process improvement (Aggarwal et al., 2019).

Notably, the TQM committee embraces evidence-based decision-making when addressing issues and concerns. Evidence-based decision-making advocates for research and the use of current findings (Aggarwal et al., 2019). A thorough analysis of data increases its credibility and reliability. To accomplish this, the committee works in concert with specialists in health informatics, such as nurse informaticists (Peltonen et al., 2019). In collaboration with health informatics specialists, the committee uses the electronic health record system to collect accurate data. In addition, online surveys and questionnaires are used to gather data (Aggarwal et al., 2019). Data analysis provides current evidence that guides the decision-making process. These findings guide the formulation of policies and standard operating procedures that guide employees’ activities (Aggarwal et al., 2019).

The TQM committee embraces open communication with all employees. The committee’s decisions are communicated via memos. Additionally, each representative conveys the committee’s proceedings to departmental employees via face-to-face interactions. Open communication provides and promotes employee feedback and involvement in the decision-making process (Maritz et al., 2019). Open communication creates inter-departmental harmony and coordination because all employees work toward common goals and are aware of the current proceedings (Maritz et al., 2019).

Deming’s Points for Total Quality Management

In addition to the principles of Total Quality Management, the TQM committee embraces Deming’s points of TQM in the decision-making process. The committee has a constant purpose of improving the quality of services. To accomplish this, it has a framework for long-term, perpetual evaluation and improvement of the quality of services at the healthcare facility (Koskela et al., 2019). Additionally, the committee creates and allocates sufficient resources to various departments to facilitate research and evidence-based practice. By so doing, its philosophy advocates for quality healthcare services that fulfil patients’ needs.

The committee seeks to eliminate overdependence on inspections by improving the quality of employees’ services. Evidence-based policies, standard operating standards, and procedures increase the quality of services and guarantee patient satisfaction (Babu & Thomas, 2020). In addition, the committee transacts with a single supplier for specific inventory. Transacting with a single supplier enables the ease of monitoring the consistency in the quality of their products (Koskela et al., 2019). For instance, if the product is of subpar quality, the supplier is notified and encouraged to improve its quality.

The committee embraces on-the-job training and refresher training. Training equips employees with relevant knowledge and skills (Nguyen & Nagase, 2019). As a result, consistency in the quality of their services is achieved. On the other hand, refresher training keeps the employees on track and maintains their competency. Advocacy for interdisciplinary collaboration promotes the exchange of ideas and continuous learning (Maritz et al., 2019). Subsequently, inter-departmental collaboration creates a team that understands organizational processes and policies and improves employees’ productivity (Maritz et al., 2019).

The TQM committee embraces leadership to eliminate fear among employees. Leadership requires the committee to address the etiology of failures among employees. Strategies such as coaching help the employees achieve their optimal potential and better quality of service delivery (Maritz et al., 2019). Techniques such as open communication, advocating for a collectivistic culture, and mutual respect help eliminate fear among employees (Maritz et al., 2019). A tension-free environment increases the honesty and accuracy of data, hence better strategic planning (Maritz et al., 2019).

Deming’s provision of eliminating numerical targets and slogans guides the committee’s policy and decision-making process. Numerical goals focus on quantity rather than quality (Maritz et al., 2019). Consequently, high output is achieved at the expense of quality. The committee emphasizes the evaluation and optimization of processes (Maritz et al., 2019). Leadership and appropriate resource allocation optimize processes and improve the quality of service. Slogans can create inter-departmental conflicts and lower the quality of service delivery (Maritz et al., 2019). Rather than creating departmental slogans, the focus is channelled toward optimizing processes, policies, and procedures to improve the quality of service delivery (Alzoubi et al., 2019).

Deming’s Plan-Do-Study-Act (PDSA) Cycle

The PDSA cycle enables the committee to evaluate the organizational processes and the quality of services and formulate strategies for continual improvement. The cycle has four steps that facilitate perpetual improvement (Braithwaite, 2022). The first phase is planning. During this phase, the goals and objectives are formulated. In addition, policies, standard operating procedures, and processes are established during this phase (Braithwaite, 2022). Metrics that indicate the quality of service delivery are formulated during this step (Braithwaite, 2022). Planning is based on the existing problem or a problem identified from a previous evaluation (Braithwaite, 2022). Proper planning is key to the success of the PDSA cycle.

The second phase involves implementing the plan. The employees implement this step (Do-step) based on the established policies and procedures (Braithwaite, 2022). Members of the committee collaborate with employees to ensure that the plan is executed in its entirety. The third step is the study step. The study step entails the evaluation of the outcomes from the second step. This phase focuses on establishing the validity, credibility, and reliability of the plan (Braithwaite, 2022). In addition, during this phase, potential areas of improvement are identified. Next, the fourth step is the Act phase. The Act phase embraces the feedback and decisions made in the third phase. Failure to achieve the desired outcome necessitates the formulation of a different plan and revisiting the PDSA cycle (Braithwaite, 2022). The cycle is perpetual to facilitate the improvement of processes and improve the quality of services (Braithwaite, 2022).

Evaluation of the Previous Plans of Action

The committee evaluated and measured the success of the previous plans of action. This is consistent with Deming’s Plan-Do-Study-Act (PDSA) Cycle (Braithwaite, 2022). Three of their previous four plans yielded the expected outcomes. The expected results were demonstrated by increased levels of patient satisfaction and lowered treatment costs related to nosocomial infections. Essentially, a decrease in the cases of nosocomial infections is an indicator of quality healthcare services and patient safety (Oner et al., 2021). A high patient satisfaction level is the ideal definition of quality in a healthcare facility. The members of the committee unanimously agreed to adopt the three plans. They reviewed the fourth plan and decided to modify the standard operating procedures and processes.

What Would Have Been Done Differently?

I would have used the same quality management evaluation model in my decision-making. I would have chosen Total Quality Management (TQM) because it involves all employees in the perpetual effort to improve organizational service quality and achieve better patient satisfaction. TQM recognizes the importance of each employee in increasing the quality of services. Additionally, TQM boosts employee morale, improves productivity, improves patient satisfaction, and gives the healthcare facility a competitive advantage (Permana et al., 2021). In addition, principles of Total Quality Management, such as a customer-focused approach, ensure that the processes are optimized to fulfil patients’ needs. The use of Deming’s PDSA cycle facilitates a continuous quality improvement process by advocating for modifying a plan that fails to achieve the expected results (Braithwaite, 2022). As a result, the quality of processes is increased, hence better patient satisfaction levels (Braithwaite, 2022).

Conclusion

I interviewed a quality manager who revealed that the TQM committee is guided by the principles of Total Quality Management, Deming’s points for TQM, and Deming’s plan-do-study-act (PDSA) cycle. The committee emphasizes in-built process quality and avoids the use of numerical targets. Similarly, I would have used the same approach because it allows continual quality improvement.

References

Aggarwal, A., Aeran, H., & Rathee, M. (2019). Quality Management in Healthcare: The Pivotal Desideratum. Journal of Oral Biology and Craniofacial Research, 9(2), 180–182. https://doi.org/10.1016/j.jobcr.2018.06.006

Alzoubi, M. M., Hayati, K. S., Rosliza, A. M., Ahmad, A. A., & Al-Hamdan, Z. M. (2019). Total Quality Management in the Health-Care Context: Integrating the Literature and Directing Future Research. Risk Management and Healthcare Policy, 12, 167–177. https://doi.org/10.2147/RMHP.S197038

Babu, F., & Thomas, S. (2020). The Relationship Between Total Quality Management Practices and Organisational Image in the Hospital Industry: An Empirical Examination. International Journal of Productivity and Quality Management, 29(1), 1–23. https://doi.org/10.1504/IJPQM.2020.104517

Braithwaite, J. (2022). Plan, Do, Study, Act (PDSA). https://www.taylorfrancis.com/chapters/edit/10.4324/9781003109945-23/plan-study-act-pdsa-jeffrey-braithwaite

Koskela, L., Tezel, A., & Patel, V. (2019). Theory of Quality Management: ITS Origins and History. 27th Annual Conference of the International Group for Lean Construction, IGLC 2019, 1381–1390. https://doi.org/10.24928/2019/0259

Maritz, R., Scheel-Sailer, A., Schmitt, K., & Prodinger, B. (2019). Overview of Quality Management Models for Inpatient Healthcare Settings. A Scoping Review. International Journal for Quality in Health Care, 31(6), 404–410. https://doi.org/10.1093/intqhc/mzy180

Nguyen, T. L. H., & Nagase, K. (2019). The Influence of Total Quality Management on Customer Satisfaction. International Journal of Healthcare Management, 12(4), 277–285. https://doi.org/10.1080/20479700.2019.1647378

Oner, B., Zengul, F. D., Oner, N., Ivankova, N. V., Karadag, A., & Patrician, P. A. (2021). Nursing-Sensitive Indicators for Nursing Care: A Systematic Review (1997–2017). Nursing Open, 8(3), 1005–1022. https://doi.org/10.1002/nop2.654

Peltonen, L.-M., Pruinelli, L., Ronquillo, C., Nibber, R., Peresmitre, E. L., Block, L., Deforest, H., Lewis, A., Alhuwail, D., Ali, S., Badger, M. K., Eler, G. J., Georgsson, M., Islam, T., Jeon, E., Jung, H., Kuo, C. H., Sarmiento, R. F. R., Sommer, J. A., Topaz, M. (2019). The current state of Nursing Informatics – An international cross-sectional survey. Finnish Journal of EHealth and EWelfare, 11(3), 220–231. https://doi.org/10.23996/fjhw.77584

Permana, A., Purba, H. H., & Rizkiyah, N. D. (2021). A systematic literature review of total quality management (TQM) implementation in the organization. International Journal of Production Management and Engineering, 9(1), 25–36. https://doi.org/10.4995/IJPME.2021.13765

Seelbach, C. L., & Brannan, G. D. (2022). Quality Management. https://www.ncbi.nlm.nih.gov/books/NBK557505/#:~:text=In%20healthcare%2C%20quality%20management%20refers,optimizing%20patient%20care%20and%20outcomes.

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Interview with a quality manager at a healthcare facility.

One cannot fully comprehend the intricacies of the healthcare environment without employing the use of their innate senses. While reading, describing and discussing Total Quality Management and Continuous Quality Improvement in healthcare may be of great benefit, true learning will only be accomplished through exposure and experience.

In this instance, you are to visit and interview a healthcare facility that has a TQM/CQI program. Observing the committee process is of greater benefit to learning. Write a research paper (8-10 pages) utilizing APA 7th edition format on your experience. Describe the healthcare facility and the members of the TQM/CQI / QA committee. Were these members appropriate in number and composition? What methodology was utilized to address concerns and issues? Were previous plans of action evaluated and measured for success? What would you have done differently? The same?
You are to utilize the principles, theories and concepts we covered during the term in analyzing this observation. Please note any outliers from what you have read. Employ several different resources to support your statements and findings.