Quality in Healthcare
Quality in health care has been a focus for some time, with Ernest Codman
proposing the "end result system of hospital standardization" in 1910. The
American College of Surgeons developed Minimum Standards for Hospitals in
1917 and the Joint Commission on Accreditation of Healthcare Organizations
(CAHO) in 1951. The National Committee for Quality Assurance (NCQA) is a
private, not-for-profit organization dedicated to improving the quality of
health care. NCQA began accrediting managed care organizations (MCOs) in
1991 in response to the need for standardized, objective information about the
quality of these organizations. To become accredited, an organization must
undergo a survey and meet certain standards designed to evaluate the health
plan's clinical and administrative systems. NCQA's Accreditation surveys look
at a health plan's efforts to continuously improve the quality of care and
service it delivers, and organizations such as the Institute for Healthcare
Improvement (IHI) have emerged to support quality improvement in health
care.
The Commission's report included 50 recommendations to address these issues,
including the use of measurements, stakeholder participation, error prevention, and
continuous improvement. SSM Health Care, profiled at the beginning of this chapter,
became one of the first health care organizations in the United States to implement
COI throughout its entire system. Other examples include Boston's New England
Deaconess Hospital, Nash General Hospital in Rocky Mount, North Carolina, and the
Virginia Beach Ambulatory Surgery Center (VBASC). Many health care organizations
notice measurable improvements from their quality initiatives, primarily in the areas
of cost reduction and increased efficiency. However, getting physicians involved in
the quality process is a difficult challenge.
Quality in Education
Education is a challenging area for quality improvement, and one of the
earliest stories of the successful use of quality in education is that of Mt.
Edgecumbe High School in Sitka, Alaska. David Langford, a teacher, brought
the quality concepts to Mt. Edgecurnbe after hearing about them at a meeting
at McDonnell- Douglas Helicopter Company. The students, with the coaching
of Langford, used quality concepts to improve school processes, such as
investigating the reasons for tardy classmates and reducing the average
number of late occurrences per week. They also dropped the traditional
grading system and instead used statistical techniques to keep track of their
own progress. Eliminating grades has had a positive effect, with one student
reporting that they found themselves learning a lot more.
The Conroe Independent School District adopted a forward-looking strategic plan in
1993 that included a TQ implementation plan that relied heavily on training and
teams. In 2001, two K-12 schools were among the first Baldrige Education winners:
Chugach School District in Alaska and Pearl River School District in New York. In 2002,
President Bush signed into law the No Child Left that has been proven to work, giving
states and districts an annual report card to measure school performance and rate
progress.
A national survey of 401 public school principals by Harris Interactive and sponsored
by the American Society for Quality (ASQ) found that U.S. elementary schools are
more advanced than secondary schools in their use of quality tools and approaches.
The majority of the principals surveyed (70 percent) believe that schools will be more
likely to adopt quality improvement programs in the future. This is due to greater
parental involvement at the elementary level. Additionally, 95% of principals report
that their school has a school improvement plan that includes measurable outcomes,
and eight in ten principals (81%) believe that improving standardized test score is
extremely or very important. Despite these findings, principals are not as likely to
measure their efforts in other areas that are important to them, such as improving
teacher satisfac-tion and morale.
Koalaty program
The American Society for Quality (ASQ) has promoted quality in elementary
education through the Koalaty Kid program. This program was an outgrowth of
activities at Frederick C. Carder Elementary School in Corning, New York, where Fred
the Koala appears throughout the schoolbulletin boards, at assemblies, in the
cafeteria and in the classrooms. In the 1980s, several teachers identified areas of
classroom errors and the principal identified factors that were most important to
student success. To address these issues, the principal developed a Plan to bring
about change throughout the whole school. Reading became a primary focus and
students were invited to read books of their own choosing.
Students were encouraged to read at home with system of contracts and incentives.
Teachers communicated the standard of work they expected in home.
In 1988, two ASQ members from Corning, Incorporated visited Carder School and
learned about the parallels to total quality. The businesspeople brought the Carder
model to the attention of ASQ headquarters, and the Society invested in a pilot
program. A Koalaty Kid steering committee was formed to oversee the effort, and it
began to emphasize a broader and more rigorous use of total quality in schools.
More than 800 U.S. schools and many overseas have adopted the approach, and
schools can utilize it to achieve their own objectives.
Active Involvement is essential for the success of Koalaty Kid schools, where
administrators, teachers, sponsors, parents, and students work together on teams
that are empowered to make decisions and implement change. These teams
represent a larger resource than the school's paid staff and can create change more
swiftly and lastingly. Outside sponsoring organizations are also important to the
success of the school, providing funds for quality training, expertise in
troubleshooting quality processes, or enrichment for academic areas. Parent
involvement is critical to the success, as they monitor homework assignments, read
aloud, identify trouble spots, and communicate with students, teachers, and
administrators about any factors that affect their children's success. Volunteers also
help the school in a variety of ways, such as supplementing the work of classroom
teachers with one-on-one tutoring, raising funds for needed equipment, and
participating actively in decision making on the school's teams.
Quality in Higher education