tqm in hospitals- grp 6
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TQM IN HOSPITALS
BY, GROUP 6RASHMI.S
RAHUL SHARMA SHILPI ADHIKARY
SISIRA.S.SASIABHILASH IYAPPAN
STATISTICS – SKM RAO – MEMBER NABH
• The Healthcare business in India is the largest after Retailing.
• Global healthcare revenue US $ 2.8 trillion
• India’s healthcare industry worth US$ 17 billion; to grow by 13% per
annum for next 6 years
• Medical tourism could account for 3-5% of the total healthcare delivery
market.
• A study by Mckinsey estimates India can earn 5000-10,000 crore by 2012
• In 2007, around 272,000 medical tourists visited India for medical tourism
and together, they brought US$ 656 Million in revenues.
• The Indian medical tourism market is expected to generate over US$ 2.5
Billion in revenues by 2012.
• -Lack of proper hospital accreditation system and inefficient laws against
malpractice are the biggest factor limiting the growth of India's medical
tourism Industry.
FACTS !!!
• Patients are the foundation of our
medical practice
• It is very obvious that they must be
satisfied
• Do we always succeed?
Some experiences
Patients tell the truth
• “Quality service? I don’t ask for much from my doctors.” The
woman, a business professional in her late 30s, seemed pleased
to be asked. “I don’t want to wait endlessly, but I understand it
if something comes up in the schedule to cause a delay – just
tell me about it! I’m much more forgiving if someone keeps me
informed”.
• “I like to feel that I have my doctor’s attention during the visit.
I don’t expect a half hour of his time, just a sense of concern.
My pediatrician is wonderful. He always remembers something
personal about my child. When he talks to me, he looks right at
me – not at his paper work or forms or does not talk on phone”
FEW GENERAL EXPECTATIONS
1. To have clinical core competence.
• Luxurious physical facilities can’t substitute for
good care
• Good clinical methods
• Exude confidence
• Rational therapy – Dr. Batra’s – emotional &
irrational fears – treatment.
• Evidence based practices - apply the best available
evidence gained from the scientific method to
medical decision making
2. Honor the appointments. Appointment system should
be accurate but flexible.
3. Communicate well with them in day to day language.
Medical jargon should be avoided.
4. To listen to their problems patiently and give them
enough time. Master the art of listening
5. Show personal concern for the patient.
Body language ,greeting , a good first impression of a
caring physician, make it visible that we are with
them in their worst times too.
6. To explain everything about the illness and treatment.
7. Staff which shows care, concern, courtesy and
empathy
8. Provide reasonably good physical facilities –
approachable location, good parking facilities
9.Impart health education: handouts, video examples
10. Proper documentation. – legible prescriptions –
mediclaim
11.To provide hospital information brochure and to have
informative sign boards
12.To have transparency in financial matters
13. To use modern technology – diagnosis & therapy
14. To have easy flow between various services. - should not
be wasting time to avail of various services
QUALITY HAS A NEW FACE WITH CQI & TPM CONCEPT IN
HOSPITAL INDUSTRY • Increase In The Number Of Service Providers
• Cost Of Service Delivery
• Emphasis On Cost-containment
• Changing Preferences Of Customers
• Changing Methods Of Service Delivery And Incidences Of Failure
In Implementation Of Tqm Are A Few Factors That Are Bringing A
Paradigm Shift In The Hospital Industry From Tqm To Cqi
(Continuous Quality Improvement) And Tpm (Total Productivity
Management),
• Hospitals , the world over are trying to deliver services according
to their patients expectations & thereby consolidate their brand
equity.
IMPLEMENTATION OF TQM IN A HOSPITAL REQUIRES:
• Strategic leadership
• Financial resources
• Employee involvement and empowerment
• Streamlining of operational activities
• Commitment at the top-level management
• Changing organisational structure to reduce bottlenecks of line and
staff conflict
• Developing a work culture for continuous learning and improvement
so that it is conducive to implementation of TQM
• Research conducted in a few Hospitals in US suggest that failure rate
in successful implementation of TQM is very high i.e. 60-67 per cent.
FAILURES IN THE IMPLEMENTATION OF TQM CAN BE DUE TO• Misconception - successful implementation of TQM - can
substantially increase market share or profitability
• Difficulty in achieving structural specifications according to
standards laid down by accreditation bodies and
standardization organizations.
• Developing processes in assembly line pattern. Every patient
requires different service in different magnitude. In case of
individual units like radio-diagnosis, pathology, support
services like laundry and cafeteria processes can be
standardized.
• Monitoring the outcome of service delivery because though
different patients suffer from same ailment even then
magnitude, degree and allied complications in each case vary.
• Due to stress on cost containment, employees perceive any
change brought by the hospital authorities as a threat to their
existence which makes implementation of new concepts an
arduous task.
• Difficulty in removing barriers on consensus for decision
making and implementation.
• Failure to identify outputs that can be quantified in terms of
revenue as against the resources invested.
TQM CAN BE SUCCESSFULLY IMPLEMENTED IN HOSPITALS IF:• Employees are made familiar with TQM concepts
• Hospital launches a data-driven decision making process based on
objective measurement criteria
• Group discussions are conducted to understand individual role in
quality improvement.
• Cross-functional team approach to problem solving is emphasised
• Internal communication plan is executed for better employee
satisfaction, motivation and co-operation.
• Physicians’ involvement is increased for improving the quality of
clinical care
• Resources are provided to implement TQM
CQI• ‘‘Continuous quality improvement is a sustained effort to streamline
operations with an objective of standardisation, cost containment and
customer satisfaction through input of available resources.”
• It is not a tool to generate revenues but it helps in increasing the
patient base by providing a brand identity in community which is
being served by hospital and thereby increasing the patient turnover.
• Develop quality circles .
• Ex: Generally, after consultation with a physician in OPD, a patient
generally is advised for diagnosis at pathology or imaging department
or both. A patient generally finds that waiting time for collection of
sample or delivery of reports is high or many of times the report is
not ready.
• In such cases, it is observed that patient is dissatisfied and despite of
high quality of clinical care he rates services of hospitals as average.
Benefits of implementing quality circles are:
• A cross-functional approach to problem solving through quality circles
provides an opportunity to all members of the circle and there is less
possibility of missing out on best possible solution.
• In cross-functional approach, employees also feel satisfied and they get
an opportunity to express their idea and discuss pros and cons of their
idea. In isolation, they may think that they have a better solution to the
problem and yet it can not be implemented. This prevents employees
from de-motivation, dissatisfaction and frustration.
• Cross-functional team approach does not require a heavy investment in
terms of money.
ACCREDATIONS –NABH & NABL
• National Accreditation Board for Hospitals & Healthcare.
• National Accreditation Board for Testing & Calibration Laboratories.
Section 1PATIENT CENTERED STANDARDSChapter StandardsAccess, Assessment & Continuity of care 15Care of patients 18Management of Medications 13Patients rights & Education 5Hospital Infection Control 9
SECTION 2HEALTH CARE ORGANIZATION MANAGEMENT STANDARDSContinous Quality Improvement 6Responsibilities of Mgmt 5Facilities Mgmt & Safety 9Human Resources Mgmt 13Information Mgmt Systems 7Total 100
SUCCESS CASE STUDIES
The Apollo Hospital in Gujarat, is a 400-bed multi-
speciality quaternary care hospital which has further
strengthened the healthcare infrastructure in the
state, emerging as benchmark in quality standards in
healthcare delivery.
Patient Services • MHC – A/v services• Pharmacy• Front Office• Nursing stations• OPD Waiting Area• Sample collection• Single/Sharing Room • Presidential Suite • LDR sensors
Infrastructure• Cardiac• Neurology• Orthopedics • Cathlab• MICU• NICU• Dialysis• Recovery• Post Operative Wards
Diagnostics• Radiology
• MRI
• CTScan
• X-Ray
• Mammography
• TMT
• Echo
• EEG
• Endoscopy
• LABS
• Biochemistry
• Microbiology
• Hematology
• Histopathology
Emergency
Physiotherapy
Blood Bank
Audiometry
Ophthalmology
Dental
General OT
MRI & Console Room
MRI is a non invasive method of mapping the internal structures of the body without the use of ionizing radiation using radio frequency signals in magnetic field.
• Most "patient friendly" 1.5 Tesla MRI
• High patient comfort with a choice of in-bore/channel music
• Total Brain scan within 5 minutes
• Whole body screening within 2 minutes
Neuro Applications
• Functional MR
• Perfusion
• Diffusion (to detect early infarcts)
• CSF flow
The only 1.5 Tesla MRI of Gujarat
Blood Bank-Laminar Airflow & Centrifuger
The Hospital is well
supported by the
Department of Transfusion
Medicine providing blood,
blood Components and
performing laboratory
investigations on blood
group serology.
"Life is precious...............
Should be cared and
saved "
Be a blood donor and
save a life.
The Only Private Blood Bank
Microbiology Lab-Bacteria, Blood & TB Culture
The Microbiology
Laboratory at the Apollo
Hospitals, serves for
diagnosis of a vast variety
of Infectious Diseases of
Bacterial, Fungal, Viral,
Parasitic or Tubercular
nature, by using state-of-art
fully automated systems
many of which are installed
for the first time in Gujarat.
The reports are available in
hours compared to several
days by conventional
methods.
Biochemistry, Hematology
Biochemistry-Immuno Analyzer
First in Gujarat, multi
parameter system for
immuno analyses and
nucleic probes &
detection. Entry of patient
data 7 analysis via
keyboard and can be
generated in form of
reports. Multiparametric
system for
immunoanalysis and
nucleocin probes
detection, management of
calibration, control and
patient data memory.
Advanced Ultrasound Machines
Emergency Nursing Station
It is different from the
rest, because with a
central nursing
station every cubicle
could be utilized as a
observation area
which reduces the
patient's mobility.
24-hour Emergency and Trauma Care
STANFORD UNIVERSITY HOSPITAL
• In Jan 1993, they went in for major restructuring to reduce costs, &
increase quality in patient specifics.
• Used a process-management approach to coordinate their quality
initiatives around the goal of moving the organization toward “patient-
centered care.”
• Significantly, although Stanford University Hospital has cut $50 million
from the budget over the past four years, their patient satisfaction
ratings have never been higher.
• With support from top management, a Patient-Centered Care Team
(PCCT) brought together managers from all areas of the hospital. Under
the direction of our consultants, Shaw Resources, the team decided to
limit its work initially to those processes that directly involve patient
care, eliminating such behind-the-scenes functions as data processing.
We also narrowed our focus to inpatient hospital care; outpatient
processes will be tackled at a later date.
• The Patient-Centered Care Team then did something that we had never considered before—we
“walked through” a typical hospital experience, from admission to discharge, from the patient’s
point of view. We supplemented our biweekly meetings with outside reading assignments and
information gathered in videotaped focus groups with former patients
• The next step was to identify specific areas to address through separate “process management
teams” of the Patient-Centered Care Team. We chose to concentrate in this first phase on the
following processes and we launched one team per month until all seven were up and running:
• Admit Patient
• Provide Laboratory Support
• Provide Hotel Services
• Provide Patient/Family Support
• Manage Patient Care
• Provide Diagnostic & Treatment Support
• Management Complaints .
• Ex: The Manage Patient Care Team asked nurse managers to proactively collect patient
complaints based on defined quality measurements. “This was a difficult transition for many of
us,” Zimmerman says. “No one wants to hear a complaint and it took a great deal of effort to
convince units that there would be no shame attached to having a high number of complaints.”
In a two-month period, managers of ten general medical-surgical units gathered 178
documented complaints
TATA MAIN HOSPITAL• The need of every patient visiting the Hospital is ‘quick, effective health care
provided in an atmosphere of comfort- ie , shorter waiting time in OPD and
for investigations and quality time spent with the doctor.
• System improvement in OPD through removal of patient registration and
regularisation of appointment system led to an appreciable reduction in
waiting time.
• Communication classes for doctors – increased communications – satisfied
patients need for increased contact time.
• MOU between doctors & clinical staff to reduce lab results- pathology,
radiological – concept of internal customers. Reduced from 380 min to 90
min.
• Infection control committee – analyse & provide corrective measures –
reduced rate of infection.
• Brought in a QIP team in Cardiology department – to reduce OPD TIME to
less than 30 min – appointment rates – segregated time slots for diff.
patients – increased pump efficiency to 90% patients seen in 30 min.
QUALITY MGMT INITIATIVES IN HIMACHAL PRADESH
HOSPITALS• Quality circles have been introduced in 40 hospitals up to
sub-divisional level in the State
• Seed money amounting to Rs. 92.00 lacs. Provided to Asptal
Kalyan Samities for quality improvement.
• State Quality standards for Health Institutions formulated
and being implemented.
• PLANNING
• Skill up gradation/ training of staff
• Improvement of delivery mechanisms to remote/tribal areas
• Accountability to PRI’s of local health staff
• Road map for incentivising staff for posting in rural areas
"Meeting the deadlines
is not good enough,
beating the deadlines is
my expectation."
-
Dhirubhai Ambani
ICE CREAM MAKER – SUBIR CHAUDHARY
THANK YOU.
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