A customized quality management implementation strategy

Austria's hospitals are not yet convinced total quality management (TQM) is a general cure for their problems. Neither competitive forces and cost consciousness nor regulations are pushing hospitals toward application of TQM methods. The Steierm?rkische Krankenanstaltengesellschaft, a multihospital corporation, used a bottom-up approach to implementation of TQM as a way of dealing with the lack of a strong quality assurance tradition.     

Eastman Kodak Company's experience with TQM in hospitals

Many companies in American industry have been practicing the methods of total quality management (TQM) for over a decade. Some of these companies are providers of health care products. Health care businesses, particularly hospitals, can benefit from their supplier relationships by learning what their vendors know about the principles and techniques of TQM. This article explores what one such supplier, the Eastman Kodak Company, has learned about implementing TQM for fast and meaningful results, using the lessons from its own experience and from consulting with some of its customer hospitals.     

全面质量管理及其在医院管理中的应用

简述了全面质量管理（TQM）的历史沿革、在企业中应用的工作原理及其基本工作法，介绍了美国、德国、日本及台湾等地推行TQM的成功经验，阐述了医院实施全面质量管理的具体步骤以及注意事项，以期对当前医院推行全面质量管理的尝试和探索有所借鉴和帮助。     

Workforce cultural factors in TQM/CQI implementation in hospitals

One of the major obstacles to successful implementation of TQM/CQI in hospitals has been management's failure to consider the workforce cultural situation. This quasi-qualitative study investigates eight workforce cultural factors in seven midwestern hospitals. Results reveal only one of the seven hospitals successfully implementing TQM/CQI.     

Structural impediments to TQM in Australian health care

The culture of quality called for by total quality management (TQM) has much to recommend it. Australian experience, however, suggests that it is not something that can easily be added to the profession-based structures and cultures prevailing in most Australian hospitals. Implementing TQM is not just a matter of advocating it. The institutional transformation implied by TQM requires additional action on multiple fronts, both internal and external to the hospital.     

The CEO experience. TQM/CQI.

The total quality movement is transforming hospital leadership. CEOs are finding that signing on to a TQM or CQI program requires intensive commitment, as well as adjustments to management style and scheduling. And it raises a host of questions about how to initiate and manage such a program--and even what to call it (TQM versus CQI). But CEOs seem ready to accept the challenge. An exclusive Hospitals survey finds that over 60 percent of the CEOs involved in TQM/CQI programs believe their involvement is "the most important thing I've ever done." Still, the proliferation of TQM/CQI in hospitals has created a backlash in the field; Donald Berwick, M.D., the "father" of TQM in health care, explains why.     

Promoting clinical involvement in hospital quality improvement efforts: the effects of top management, board, and physician leadership.

STUDY QUESTION: An examination of the effects of top management, board, and physician leadership for quality on the extent of clinical involvement in hospital CQI/TQM efforts. DATA SOURCES: A sample of 2,193 acute care community hospitals, created by merging data from a 1989 national survey on hospital governance and a 1993 national survey on hospital quality improvement efforts. STUDY DESIGN: Hypotheses were tested using Heckman's two-stage modeling approach. Four dimensions of clinical involvement in CQI/TQM were examined: physician participation in formal QI training, physician participation in QI teams, clinical departments with formally organized QA/QI project teams, and clinical conditions and procedures for which quality of care data are used by formally organized QA/QI project teams. Leadership measures included CEO involvement in CQI/TQM, board quality monitoring, board activity in quality improvement, active-staff physician involvement in governance, and physician-at-large involvement in governance. Relevant control variables were included in the analysis. PRINCIPAL FINDINGS: Measures of top management leadership for quality and board leadership for quality showed significant, positive relationships with measures of clinical involvement in CQI/TQM. Active-staff physician involvement in governance showed positive, significant relationships with clinical involvement measures, while physician-at-large involvement in governance showed significant, negative relationships. CONCLUSIONS: Study results suggest that leadership from the top promotes clinical involvement in CQI/TQM. Further, results indicate that leadership for quality in healthcare settings may issue from several sources, including managers, boards, and physician leaders.     

Clinical nutrition and foodservice personnel in teaching hospitals have different perceptions of total quality management performance

OBJECTIVE: To investigate the perceived total quality management (TQM) performance of their department by clinical nutrition managers and dietitians, and foodservice managers and supervisors, in hospital food and nutrition service departments. DESIGN: Using a 2-part questionnaire containing items about 3 constructs of TQM performance and demographic characteristics, participants rated their perceptions of TQM performance. SUBJECTS: Employees in 7 Council of Teaching Hospitals. Of the 128 possible respondents, 73 (57%) completed the study. STATISTICAL ANALYSES PERFORMED: Correlation analysis to identify relationships between demographic characteristics and TQM performance. Analysis of variance to investigate statistical differences among hospitals and between subject groups and types of employment positions. RESULTS: Three TQM constructs--organization, information, and quality management--were evaluated. The clinical nutrition manager and dietitian group had mean ratings between 3.1 and 4.7 (5-point Likert scale); the foodservice manager and supervisor group had mean ratings from 2.7 to 4.0. Education level was significantly correlated (r = 0.44) to performance of employee training in the clinical nutrition group. The number of employees directly supervised was negatively correlated (r = -0.21) to the performance of employee training in the foodservice group. APPLICATIONS: As the dynamic roles of dietitians change, many dietitians will occupy management positions in organizations such as restaurants, health food stores, food processing/distribution companies, and schools. This study demonstrates how a TQM survey instrument could be applied to clinical nutrition and foodservice settings. Dietitians will need to assess TQM in their workplace facilities, especially because of the direct links of TQM to productivity and client satisfaction.     

TQM shifts hospital-vendor focus to total value, productivity.

The movement toward total quality management (TQM) is not only overturning the old ways of doing things within hospitals, it's transforming working relationships with vendors as well. A number of institutions are trying innovative approaches to purchasing, including vendor certification programs.     

Improving hospital performance: issues in assessing the impact of TQM activities

Despite numerous published reports of the need for TQM activities in health care organizations and their widespread diffusion within the health care industry, whether they make a difference remains an unresolved issue. In this article, we discuss the major reasons why the impacts of TQM should be assessed, what needs to be measured during assessment activities, and significant methodological issues that can confound the evaluation of TQM effects. An audit framework is described that can be used to depict the types of effects that TQM may have on the performance of health care organizations. Assessment guidelines are offered that will hopefully benefit the future efforts of institutional managers and health services researchers in their attempts to determine whether TQM activities do in fact make a significant difference.     

Beyond resource management: towards total quality

Suggests that health organizations which have successfully introduced devolved management by involving clinicians are reaching a position where they can move forward beyond "Resource Management" towards managing in a total quality way. This is not an in-depth explanation of TQM (which in itself is rarely understood) but a brief examination of how health organizations can move towards becoming total quality organizations. The trend to decentralize the management of clinical services in hospitals is seen in many countries across the world and where well established, the natural evolution has been towards total quality management.     

What makes for successful TQM in the NHS?

A three-year evaluation of total quality management (TQM) at NHS demonstration sites shows there are clear factors which predict successful implementation of TQM. The intention is to raise awareness at both TQM and non-TQM sites of the need to have a structured, pre-planned approach to TQM, based on a thorough understanding of alternative approaches.     

The presence of total quality management and continuous quality improvement processes in California public health clinics.

Total quality management (TQM) and continuous quality improvement (CQI) processes have not been fully integrated into public health practice. Current levels of participation and interest in TQM/CQI were assessed in California's 62 county departments of health services. Survey results indicated that only 18.5 percent of the 54 respondents were using TQM/CQI. Of those not using TQM/CQI, 75 percent were interested in these activities. Improvement of public health clinic ability to compete and to survive in a rapidly changing health care environment requires fostering this interest through public health decision-maker support, increased TQM/CQI training opportunities, and demonstration of TQM/CQI cost-effectiveness in public health.     

Development of a customer service program in a large, multi-site blood bank

The concepts of Total Quality Management (TQM) and Continuous Quality Improvement (CQI) have been widely applied but not in the unique ambulatory care setting represented by Irwin Memorial Blood Centers (IMBC). The traditional definition of quality for blood banks has been concerned with the products offered to physicians, hospitals and patients. This program expanded the definition to include customer service. A Quality of Service Steering Committee (QSSC) identified the needs and requirements of Irwin's key customer groups as a first step in embarking on its Quality of Service Program (QSP).     

A quality cure for healthcare

It is the watchword of the '90s in every industry, including healthcare. PROFILES talked to three hospitals midway through their TQM/CQI efforts to find out how they got where they are and where they plan to go. They shared their mission statements, management expectations, quality newsletters, a clever "brag quotient," their problem-solving systems, flow charts, and a continuous improvement roadmap.     

Analyzing the ambiguous relationship between efficiency,quality and patient satisfaction in healthcare services: The case of public hospitals in Turkey

Objective

This paper empirically analyzes the effects of efficiency and structural quality on patient satisfaction in Turkish public hospitals. It also investigates the controversial relationship between hospital efficiency and structural quality for small, medium and large size hospitals in a comparative perspective.

Methods

Data envelopment analysis (DEA) is used to analyze the efficiencies of hospitals. Data concerning 523 public hospitals is obtained from Turkish Ministry of Health. Due to the missing data of some hospitals, the sample of this study is composed of the remaining 348 observations. Multiple regression analysis is used to evaluate the relationship between patient satisfaction as a dependent variable and structural quality, hospital efficiency and institutional factors as independent variables. Furthermore, stepwise process multiple regression analysis is used to analyze the moderator effects of hospital efficiency on the form of the relationship between quality and satisfaction.

Findings

The findings indicate that hospital efficiency changes the form of the relationship between structural quality and patient satisfaction as a moderator variable. The trade-off between quality and efficiency is found to vary depending on the hospital size. Negative correlation is found between quality and efficiency for small-size hospitals. However, positive correlation between efficiency and quality is found significant as indicated by Total Quality Management (TQM) approach for large-size hospitals. This study also provides the empirical evidence on the negative relationship between patient satisfaction and hospital size.

Conclusions

The effect of hospital efficiency on patient satisfaction might be improved for inefficient small and medium size hospitals by taking successful large hospitals as role models.     

An evaluation of TQM in primary care: in search of best practice

Presents an evaluation of a TQM initiative which was designed to help the general level of awareness and knowledge within general practices and to encourage the implementation of TQM in primary care. The purposes of the initiative were to assess the effectiveness of the TQM approach used, not only in terms of tangible results but also in terms of cost effectiveness suitability and workability; and to check the transferability of the model used and its replicability with similar levels of benefits in other general practices on a nationwide basis.     

The quest for quality and productivity in health services

The leaders of health care organizations across the country are facing significant pressures to improve the quality of their services while reducing the rate of cost increases within the industry. Total Quality Management (TQM) has been credited, by many leaders in the manufacturing industry, as an effective tool to manage their organizations. This article presents key concepts of TQM as discussed by quality experts, namely, Deming, Juran, and Crosby. It discusses 12 key concepts that have formed the foundation of TQM implementation at Henry Ford Health System. The process of implementation is presented in detail, and the role of TQM in clinical applications is discussed. Success factors and visible actions by senior management designed to reinforce the implementation of TQM in any organization are presented.     

Organizational Learning and Continuous Quality Improvement: Examining the Impact on Nursing Home Performance

Interest is growing in learning more about the ability of total quality management and continuous quality improvement (TQM/CQI) initiatives to contribute to the performance of healthcare organizations. A major factor in the successful implementation of TQM/CQI is the seminal contribution of an organization's culture. Many implementation efforts have not succeeded because of a corporate culture that failed to stress broader organizational learning. This may help to explain why some TQM/CQI programs have been unsuccessful in improving healthcare organization performance. Organizational performance variables and organizational learning orientation were assessed in a sample of 181 Canadian long-term care organizations that had implemented a formal TQM/CQI program. Categorical regression analysis shows that, in the absence of a strong corporate culture that stresses organizational learning and employee development, few performance enhancements are reported. The results of the assessment suggest that a TQM/CQI program without the backing of a strong organizational learning culture may be insufficient to achieve augmented organizational performance.