nursing leadership and management course / total quality mnagement
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Prepared by
Mouad Hourani RN,BSN,MPH.
Nursing Quality Supervisor
Oct.2014
Nursing Management and
Leadership course
Total Quality Management
Sultan Bin Abdul-Aziz Humanitarian City
Nursing Services
Table of contents
1. What is Quality?
2. Definition of Quality in healthcare?
3. Quality Evolution .
4. Quality control.
5. Quality Assurance.
6. Total Quality Management.
7. Old vs. TQM Approach.
8. The Deming, Juran and Crosby philosophies.
9. Quality Principles.
10. Why Quality?
11. Quality perspectives.
12. Key Dimensions of Quality.
13. Good Managers (Leaders)
What is Quality?
Fitness to use
Excellence
Satisfaction
Standard are created when the experts
are able to understand what the right
things are and how the right things are
best achieved.
QA,QC,TQM
Definitions of Quality in Health care
Quality as dictionary defined (Webster's new world college and American heritage dictionaries):
Having a high degree of excellence
Doing the right things right the first time
1. Freedom from deficiencies :
freedom from any avoidable intervention
required to achieve an equivalent outcome
Ex:Nosocomial infection, lost lab result etc.
2. Product features:
services attract and satisfy patients ,meet
customer expectation and distinguish one
organization from others
Ex: computerized health record, follow up
care
Juran institute defines quality as
Accessible, effective, safe, accountable, and fair
This means:
Providers deliver the right care to the right patient at the right time in the right way.
Patients can access timely care, have accurate and understandable information about risks and benefits ,are protected from unsafe health care services and have reliable and understandable information on the care they receive.
Both patients and clinicians have their rights respected.
AHRQ and AHCPR Defines Quality: AHRQ (the U.S Government Agency for Healthcare Research Quality)
AHCPR ( Agency for Healthcare Policy and Research)
Quality Evolution
Inspection
Quality
Control
Quality
Assurance
Total Quality
Management
Reactive Approach
Proactive Approach
Detection
Finding & Fixing
mistakes
Prevention
Stop defects at source.
Zero defects
1
2
3
4
Inspect products
Incorporates QC/QA activities into a
company-wide system aimed at
satisfying the customer.
(involves all organizational functions)
Planned and systematic actions to
insure that products or services
conform to company requirements
Operational techniques to make
inspection more efficient & to
reduce the costs of quality.
(example: SPC)
Quality Control
The purpose of quality control is to uncover defects
and have them corrected so that defect-free products
will be produced.
Quality control is limited to looking at products .
Quality control is testing the final product against
product quality standards.
Quality control is operational techniques that are used to
fulfill requirements for product quality.
Juran says, software quality control is the process of measuring actual
quality, comparing this to some standard, and then acting on the
discrepancy.
Quality Assurance
Quality assurance is oriented toward preventing defects.
It is defined by those activities that modify the
development processes to prevent the introduction of
defects.
Quality assurance is more concerned with the processes
that produce the final product, and making sure that
quality is part of each phase.
QA is about maturing the process towards minimum
defect.
It is about balancing methodology, leadership, and
technology.
It is about taking into account human factors as well as
technological ones.
Total Quality Management
Philosophy of TQM revolves around customer driven
management.
Its major emphasis is on determining customer need or
expectation from the product.
Total Quality is the culture of the organization.
It is attitude of people how they perform their assigned
work with aims to provide, customers with products and
services that satisfy their needs.
The culture change means all members of the
organization participate in the improvement of process,
products, and services.
TQM Philosophy
“Do the right things, right the first time, every time”
You must put a quality product into QC before you can
expect to get out one, otherwise wastage (or rework) will be
very high.
Total QM Philosophy
The concept of TQM as advocated by
management theorists and industrial
engineers has been adopted by healthcare
leaders.
Definition of TQM: involving quality and
leadership commitment which provide the
energy and rationale for implementation of
the process of CQI within the organization
wide quality strategy.
Old vs. TQM Approach
Quality Element
Previous Approach
TQM Approach
Definition Product-oriented
Customer-oriented
Priorities 2nd to service and
cost
Equals of service and cost Decisions
Short-term
Long-term
Emphasis
Detection
Prevention
Errors
Operations
System
Responsibility
Quality control
Everyone
Problem Solving
Managers
Teams
Procurement
Price
Life-cycle
costs,partnership
Manager’s Role
Plan, assign, control,
and enforce
Delegate, coach,
facilitate and mentor
The Deming philosophy
14 points for management:
1. Create and publish to all employees a statement of
the aims and purposes of the company. The
management must demonstrate their commitment to
this statement.
2. Learn the new philosophy.
3. Understand the purpose of inspection – to reduce the
cost and improve the processes.
4. End the practice of awarding business on the basis of
price tag alone.
5. Improve constantly and forever the system of
production and service.
6. Institute training
7. Teach and institute leadership.
8. Drive out fear. Create an environment of innovation.
9. Optimize the team efforts towards the aims and
purposes of the company.
10. Eliminate exhortations for the workforce.
11. Eliminate numerical quotas for production.
12. Remove the barriers that rob pride of workmanship.
13. Encourage learning and self-improvement.
14. Take action to accomplish the transformation.
The Deming philosophy
The Juran philosophy
Quality Trilogy:
1. Quality planning: Process of preparing to meet
quality goals. Involves understanding customer needs
and developing product features.
2. Quality control: Process of meeting quality goals
during operations. Control parameters. Measuring the
deviation and taking action.
3. Quality improvement: Process for breaking through
to unprecedented levels of performance. Identify areas
of improvement and get the right people to bring about
the change.
The Crosby philosophy
Absolute’s of Management
Quality means conformance to requirements not elegance.
There is no such thing as quality problem.
There is no such thing as economics of quality: it is always cheaper to do the job right the first time.
The only performance measurement is the cost of quality: the cost of non-conformance.
Basic Elements of Improvement
Determination (commitment by the top management)
Education (of the employees towards Zero Defects (ZD))
Implementation (of the organizational processes towards ZD)
Quality Management Principle:
Customers(internal and external):needs,
expectations.
Employees/staff: expertise, recommendation,
access to top management, involvement in
planning and decision making.
Management: commitment, empowerment of
employees.
Teamwork .
Focus on process and system rather than
individual.
Focus on prevention rather than
inspection
Use of formal problem solving methods
and statistical tools
Quality Management Principle: Cont..
Why Quality?
Eliminate hazard to patient
Eliminate rework
Save time and money
Desire for recognition and the strive for
excellence
Pressure of competition and to enhance
marketing
Requirement to define and meet patient needs
and expectations
Accreditation ,certification
Quality perspectives
Everyone defines Quality based on their own perspective of it. Typical responses about the definition of quality would include:
1. Perfection
2. Consistency
3. Eliminating waste
4. Speed of delivery
5. Compliance with policies and procedures
6. Doing it right the first time
7. Delighting or pleasing customers
8. Total customer satisfaction and service
1. Appropriateness:
The degree to which the care and services
provided are relevant to the patients clinical
needs.
Is the intervention correct? given the
needs?
2. Availability:
Is there sufficient access to care?
Key Dimensions of Quality:
3. Competency:
practitioners ability to produce customer
satisfaction and adheres to standards of
care
Are practitioners qualified to provide the
care?
4. Continuity:
Are the care provided in continuous
way?
5. Effectiveness :
Are positive outcomes are reached?
6. Efficiency:
The relationship between outcome and
the resources used to deliver patient care.
Are the treatment provided in manner
that conserve resources?
7. Safety :
avoid the risks for patients and health
care providers
8. Timeliness:
provide the health care at the most
necessary time
Good Managers (Leaders)
1. Give priority attention to customers and their
needs
2. Empower, rather than control, subordinates.
3. Emphasize improvement rather than
maintenance.
4. They emphasize prevention.
5. Encourage collaboration rather than
competition.
6. They train and coach, rather than direct and
supervise.
7. Learn from problems.
8. They continually try to improve
communications.
9. They continually demonstrate their
commitment to quality.
10. Choose suppliers on the basis of quality, not
price.
11. Establish organizational systems to support
the quality effort.
12. Encourage and recognize team effort. Total Quality Management
Good Managers (Leaders)
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