THE CONCEPT OF T.Q.M. IN
HEALTHCARE
“Quality”
 Having
 Doing
 Is
high degree of excellence
right things right first time
cost - reduction, not a cost
Concepts
WHAT IS QUALITY?

Freedom from deficiency

Product feature
TQM as a management philosophy
Aims to:
Customer service
Productivity
Profits
Market share
Cost
T.Q.M.
It is a broad management philosophy,
espousing quality and leadership
commitment, which provides the energy and
the rationale for implementation of the
process of continuous quality improvement
within the organization wide quality strategy.
Aspects of Quality
1.
2.
3.
Measurable
Appreciative
Perceptive
Dimensions of Quality






 Availability
Appropriateness
 Continuity
Competency
 Efficacy
Effectiveness
 Safety
Efficiency
 Respect and care
Timeliness
Prevention and early detection
Key Concepts of TQM












Top management leadership
Creating corporate framework for quality
Transformation of corporate culture
Customer focus
Process-focus
Collaborative approach to process improvement!
Employee education & training
Learning by practice & teaching
Benchmarking
Quality measurement & statistics
Recognition & reward
Management integration
TQM believes in the values of:
1.
2.
-
Customers:
Needs
Expectations
Opinions
Staff:
Willingness & desire
Abilities & desire
Opinions
Access to Top Management
Involvement in:
1.
2.
3.
4.
DECISION MAKING
PROBLEM SOLVING
GOAL SETTING
PLANNING
3.
-
4.
-
-
Management:
Commitment & Visibility
Active Leadership
Participation
Empowerment of Employee
Accountability
Teamwork:
Unity
Ownership
More & better ideas
Openness
Encouragement
Mutual respect
Incentive & reward
Basic Elements of A Process
Supplier
Inputs
Processors
Sequence of steps
Customers
Output
System, Function, Process & Step
System
Function
Function
Process
Step
Process
Step
Process
Step
Process
Step
Module of Donabedian
CAUSAL RELATIONSHIP
Structure
Effective
Process
Efficient
Outcome
Good
Change in Emphasis
-
-
-
In part focus on
What of care i.e. patient care GIVEN.
Who of care i.e. patient care GIVER.
Concentrate on improving system & process,
most of the time:The how of care
patient care PROCESS
The result of care
patient care OUTCOME
Structure
The arrangement of parts of care system or
elements that facilitate care
e.g.
Resources
Equipment
Number of staff
Qualification of staff
Work space
Process
Refer to the procedures, methods, means
or sequence of steps for providing or
delivering care, producing outcomes.
- Clinical process
- Care delivery process
Outcome
Refers to the results of care, adverse or
beneficial e.g.
CLINICAL
- Short term
- Complication
FUNCTIONAL
- Long term health status
- Activities of daily living
PERCEIVED
Patient / family satisfaction
Quality Management Trilogy



Control / measurement
Improvement
Planning
Continuous Quality Improvement
Process
DO
PLAN
STUDY
ACT
Decision Making: Traditional Model
(Data Deficient)
Intuition
Opinion
Logic
Rationalization
Rumor
Hearsay
Recommendations/
Action
NO DEFINED PROCESS
Decision Making: Q.M. Model
(Data-based)
Q. Planning
Interpretation/
Understanding
Q. Improvement
Decision
Decision
Knowledge
Information
Statistical
Analysis
Q. Control
Proposal/
Hypothesis
Design
Data
Collection
General Management Functions
Management is the sum of these
activities to improve human and material
resources toward achievement of stated
goals.





PLANNING
ORGANIZING & STAFFING
DIRECTING
COORDINATING
IMPROVING
Core Quality Improvement Standards




Quality leadership
Data collection for quality monitoring
Analysis of monitoring data
Quality improvement
Do We Need These?







Medical record
Information system
Protocol & clinical guidelines
Teaching session
Appraisal system
Review / audit of mortality & morbidity
Quality department