TQM/CQI in business and health care. An overview.

TQM/CQI is increasingly being used by U.S. companies and the health care industry to improve their operations and profitability. TQM/CQI can be used by occupational health nurses to help focus efforts to improve their health services and demonstrate their value. TQM/CQI also is used by businesses to improve the quality and cost of external health services. Occupational health nurses who are knowledgeable in TQM/CQI can help assure the quality of external health services as businesses strive to reduce rising health care costs.     

TQM/CQI: Providing a Steady Supply of Nurses for the Future

The recent emphasis on total quality management and continuous quality improvement (TQM/CQI) is a positive way to improve the professional status of nurses and minimize repetitive cycles of nursing shortages. The author reviews the history and the current status of the supply and demand for nursing personnel, and suggests solutions for preventing shortages that incorporate TQM/CQI strategies.     

Engaging students in a QI/QM presentation to enhance QSEN concept learning

The Quality and Safety Education for Nurses (QSEN) Initiative addresses goals to better prepare future nurses by proposing and defining 6 competencies addressing knowledge, skills, and attitudes (KSA) needed for undergraduate, pre-licensure nursing students to be successful, competent, and qualified registered nurses. Educators maintain the responsibility to bridge education and clinical preparation to enable nursing students to practice at a level that projects quality and safety. This article introduces and explains a guided Quality Indicator/Quality Measure (QI/QM) teaching-learning strategy aimed at the promotion of learning about QSEN competencies, in which students identify a clinical QI/QM issue, gather data, collaborate, apply research techniques, create a presentation, and report their findings. Specific QSEN competency sub-scores from an NCLEX test preparation strategy were used to measure students’ learning, and improvements on these sub-scores were observed. Introducing QSEN concepts sets the stage for competent nursing care in the future and this valuable teaching-learning strategy suggests how to infuse QSEN competencies into an undergraduate nursing curriculum.     

The CQI pathway

The use of CQI to identify issues, processes, and methods of quality management was a favorable learning experience for the Botsford General rehabilitation staff. They experienced improved interdepartmental communication and enhanced understanding of the roles and responsibilities of other disciplines, as well as the overall CQI process. The use of the CQI process accomplished the objective of decreasing the length of stay of patients with amputations by 6 to 8 days, thereby reducing costs. Use of flowcharting to outline a typical patient stay from admission to discharge helped to clarify potential problems, eliminate unnecessary steps, and reduce documentation time. Although rehabilitation services are currently exempt from diagnosis-related group application, in order to maintain cost efficiency and service effectiveness, it behooves us to continually track and stay in line with the competition. In light of anticipated health care reforms, the rehabilitation industry must be proactive in its management of service delivery with an emphasis on functional outcomes. Botsford General's success with using a critical pathway for the amputee program as part of a program evaluation system will lead to the development of critical pathways for additional diagnoses.     

Wide application of CQI in home care

Organizations are often overwhelmed when faced with a need to develop a comprehensive quality improvement program and use a cross-organizational team to improve outcomes. This article describes the total quality management program implemented in a long-term home health care program in New York State. It describes common issues, such as incidents, multidisciplinary clinical record documentation audits, and staff competency. As a result of this comprehensive performance improvement process, this organization has not only changed the manner in which it operates but also improved its performance.     

Implementing CQI: measuring levels of service quality at physiotherapy clinics

The purpose of this study was to provide a profile of patient perceptions of the service quality delivered by a back pain rehabilitation clinic. Data were gathered and analyzed at the clinic level in twelve different locations across Canada. Measurement techniques were based on validated survey methods and developed from a growing stream of social science research. Results provided clinic managers with a profile of perceived service quality in terms of three key aspects: administrative support, quality of therapy received, and satisfaction with the results. The results also provided each clinic with benchmarks so that on-going service quality measurements can be incorporated into a system of continuous quality improvement. This process can assist rehabilitation clinics (and other health care providers) in improving service as well as ultimately reducing the costs of providing treatments involving physiotherapy.     

Total Quality Management (TQM) in the Non-Profit Setting

Unforeseen issues during the 1980s slowly eroded the infrastructure of the Woodbourne Center, a residential treatment center in Baltimore, Maryland. A search for alternative organizational and management styles was initiated to minimize a sense of mistrust in management, inconsistency in accountability, and ineffective flow of communication. Total Quality Management, TQM, was selected as a possible solution. This paper presents the Woodbourne experience in implementing TQM in a residential treatment center. Discussed are: (I) components of TQM selected for adoption; (2) techniques for identifying issues and problem areas; and (3) assessment. Resented are twelve month data indicating personal and professional growth and sustained attitudiial changes in locus of control and self-efficacy. A discussion of the role of TQM within the auspices of the residential treatment center is presented.     

国内护理学教育中5种参与式教学方法综述

参与式教学是以学习者为中心、应用灵活多样、让不同层次的学生都有参与和发展机会的一种有效的教学方式，能够提高学生学习积极性。国内应用较多的参与式教学法包括分组讨论、案例分析及角色扮演。为了适应不同学生的学习需要，进一步促进国内护理学教育的发展，作者对国内护理学教育中应用较少的5种参与式教学方法（拼图式教学法、用脚投票教学法、一分钟论文教学法、配对教学法和卡片粘贴教学法）的内涵、实施方法、优势及应用情况进行了综述。     

应用CQI加强新生儿配奶间的医院感染管理

目的观察持续性质量改进(CQI)措施对提高新生儿奶液合格率的可能性。方法通过加强管理措施和细菌学评价方法,对贯彻持续性质量改进措施效果进行评价。结果通过实施CQI措施之后,新生儿奶液及其相关物品和工作人员手上检出细菌数逐渐降低,合格率不断提高,确保了奶液卫生质量。结论CQI可在短期内改进新生儿配奶间医院感染管理成效,提高奶液合格率。