Total Quality Management (TQM) in Healthcare

Total Quality Management (TQM)

Total Quality Management (TQM) may have been the first quality oriented philosophy to transition into healthcare.   TQM is based on three principles: continuous quality improvement (CQI), customer focus, and teamwork.  To date, limited research attention has been given to challenges involved in adopting such practices to healthcare.  Despite the enthusiasm raised by the potential benefits, many initiatives have not fully delivered the promised results.  Some of the reasons for failure can be traced to the insufficient support of health professionals, the lack of leadership commitment and the tendency to look at TQM in isolation rather than putting it at core of the institution’s strategy.   Moreover, there exist various powerful subcultures (e.g. manager’s subculture, physician’s subculture, etc), each one of whom has their own perspective of what quality should be and how the work should be done (Hanna & Sethuraman, 2005). 

Continuous Quality Improvement (CQI)

Continuous quality improvement is a concept based on a Japanese philosophy of “kaizen,” the principle of which is based on continually seeking improvement on a process or system. The underlying belief on continuous improvement is that any aspect of a process or system can be improved.  The focus is not to wait for a big problem to occur before acting (linkedin.com).

CQI involves simplifying a process or a task and a lot of it was due to the computer application, automation, and processes that have exploded in the late 1980s. Medical has been slow in adapting to it.  Healthcare is notorious for its enormous knowledge base, the vast array of data that are devoted to patient care, and the complexity of those data. Yet many clinicians and hospitals still rely on paper and pen to record data, on charts and files to store data, and on their reliance to cognitive memory or searching abilities to find—in stacks of charts, files, books, journals, and literature summaries—data and information to support decisions.

An example of this is a clinical laboratory in Southern California that still believes in manually inputting their timecard and the breakdown of their daily workload.  Anecdotal accounts indicates that many workers at this particular department  complained at the end of the day that after looking at hundreds if not thousands of cells in a microscope, manually inputting numbers is just an enormous task.  The matter was brought up to the managers attention and some workers in the department even  made an effort to simplify the process through use of Excel spreadsheet, but the managers of the place called it “cheating.”  The Excel program was discarded. This is a classic example of an archaic manager subculture at workplace of which each has their perspective of how the work should be done.

Customer Service

Kelly (2006), emphasized the responsibility of managers in instilling a customer focused environment and direction for employees, including adherence to the dual nature of medical quality. Continuous quality improvement (CQI) in health care espouses customer service and stakeholders define it based on their expectations and needs.  For instance, in an effort to provide better customer focused environment, a big clinical lab in San Diego has rebranded their initiative as Vision for the Future and Beyond. The goal: to find ways to work better, what the organization could do differently to improve the way they serviced customers, improve what they offered customers, improve the way they operate, and improve their overall service to patients, customers and our employees. The renaming was embraced by everyone and hundreds of initiatives and projects sprang up, and were prioritized.

Teamwork

Teamwork means employee involvement in quality.  As such, the people involved have a common goal and purpose. The members of the team work together, rather than delegating to subordinates, their performance is judged not only by individual contributions but also by group contributions, and the members have an overarching purpose that transcends individual priorities.  Patient care teams in a hospital provide for all kinds of services, from prevention, to acute care, and to the end-of-life (Kelly, 2006).

Conclusion

For total quality to be implemented, one strategy is to have the leaders of the organization steer the workforce in the right direction. In this author’s introductory paragraph, it was emphasized that some of the reasons for failure of continuous quality improvement can be traced to the insufficient support of health professionals, the lack of leadership commitment and the tendency to look at TQM in isolation rather than putting it at core of the institution’s strategy.   Moreover, there exist various powerful subcultures (e.g. manager’s subculture, physician’s subculture, etc),  each one of whom has their own perspective of what quality should be and how the work should be done . Leaders of an organization have a major role in the development of an organizational culture that is supportive of organizational improvement. The leader of the organization must foster total employee involvement in the quest for excellent service quality.

 

Cesar Aquino has an MBA in Healthcare Mangement and currently a PhD Candidate in Healthcare Administration

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