Basic Concept of

Quality

By: Dr. Mushtaq Khosa

TQM DirectorAlith General Hospital

What is Quality• Beauty

• Goodness

• Freshness

Degree of excellence

• Expensiveness

Quality

Totality of characteristics of an entity that bear on its ability to satisfy and needs.(ISO)

impliedstated

Quality

100% Customer Satisfaction

QualityZero Defects “DRIFT”

Process

Output

Total Quality Management

TQM is a management strategy that continuously improves the quality of the services/products and its process.

GOOD PERFORMANCE

POOR PERFORMANCE

GO

OD

PR

OC

ES

S

Antibiotic administered 2 hours prior to surgery.

OR Team performs Time Out before the procedure.

Nurse sucessfuly inserted ET Tube to the desaturated patient.

Nurse pushes the 10ml remaining potassium infusion.

Theorist

Shewhart

Deming

Juran

Fiegenbaum

STATISTICAL CHART

QUALITY CONTROL HANDBOOK

PDCA CYCLE

QUALITY CONTROL

(1923)

(1951)

Primary Elements of TQM

Change AgentCommitmentSupport

Everyone is responsible

Journey with no end

Determines the level of quality

Series of steps

Decision Making based on Data

Plan to achieve common Goals (Vision & Mission)

Role of Leadership in TQM• Leading from the front.• Promoting cultural change.• Opens Communication.• Instilling more customer focus.• Inspire and influence employees to

become willing followers in the achievement of organizational goals.

• Role model for Quality.

Role of HODs in TQM• Act as a facilitator of Quality

Improvement within the department.• a strong source of inspiration for

other employees.• Responsible for the development of

their staffs and department.• Set standards, formulate Policies and

Procedures within the department.

Role of the Staffs in TQM

• At every level within an organization whatever your activity is, you are responsible for quality, from introducing the system to supervising, monitoring and implementing it on day to day basis.

Job Description• A written statement of a specific job,

based on the findings of a job analysis.• Includes duties, purpose,

responsibilities, scope, and working conditions of a job along with the job's title, and the name or designation of the person to whom the employee reports.

• Job description usually forms the basis of job specification.

Policy and Procedures

• A set of policies determining the  principles, rules, and guidelines which are formulated or adopted by an organization to reach its long-term goals.

• Policies and procedures are designed to influence and determine all major decisions and actions, and all activities take place within the boundaries set by them.

Dimensions of QualityQuality is doing the Right Thing

• Appropriateness• Efficacy

Right first time • Effectiveness • Accessibility• Timeliness• Safety • Continuity• Efficiency• Respect & Care

FOCUS-PDCAData of Nursing Indicators show high incidence of Hospital Acquired Pressure Ulcers in the Ward.

Dept. 1433 1434

ER 6 5

DR 3 4

NICU 3 2

WARD 20 21

AKU 2 3

Total 34 29Team Leader :Director of Nursing

Facilitator: Nursing Quality Staff

Team Members:

2-Head Nurse1-Ward Staff1- Surgery Specialist

Find

Organize

FOCUS-PDCA

Patient arrived in the Ward

Assess for the presence of Pressure Ulcer

OVR

Refer to GS

Preventive Measures

Implement Pressure Ulcer Care

Follow Up

Yes

Pressure ulcer

No

Clarify

FOCUS-PDCAUnderstand

Increase incidence of HAPU

Manpower Methods

EnvironmentMaterial

Assessment(not done/Improper)

Positioning( not done as required)

Nurse Shortage

Staff Attitude(non compliance to pressure ulcer assessment and preventive measures)

Busy Ward

Long Stay Patient

Lack of Air Mattress

Shortage of Pillow

Patient’s Bed not functioning

No P&P

FOCUS-PDCA

Select

P&P on Pressure Ulcer Prevention and Management

Adopt Pressure Ulcer Assessment Tool (e.g. BRADEN SCALE)Braden_Scale.pdf

Intensive education on Pressure Ulcer Assessment

Implement monitoring system of high risk patients

Provision of needed equipment's and materials

FOCUS-PDCA

Plan

• P&P on Pressure ulcer Assessment (BRADEN SCALE)• Request for Administration Support regarding continuous

provision of required materials/equipment.• Create a team that will monitor the patients at risk of

developing pressure ulcers regularly for proper care and intervention.

• Intensive teaching to improve staff skills, develop staff practices/ experience, and heighten awareness of the new P&P.

Do

• P&P was made, Pressure Ulcer Assessment Tool was Implemented.

• High Risk patients was monitored to ensure preventive measures were implemented.

• Continuous Nursing Education for prevention of Pressure Ulcer.

• Additional materials and supply were provided.

FOCUS-PDCA

Check

• Reduction of Pressure Ulcer on the 1st quarter of 1435 was noted.

Act

• Continuous monitoring.• +Implement in other

units after positive evaluation is achieved.

• -Revision of P&P.

Dept. 1433 1434 1st Q1435

ER 6 5 3

DR 3 4 3

NICU 3 2 2

WARD 20 21 13

AKU 2 3 1

Total 34 29 22

Obstacles of TQM Implementation

• Lack of management commitment.• Inability to change the organizational

culture.• Improper Planning.• Lack of continuous training and education.• Isolated individual and department.• Inadequate attention to customers.• Inadequate use of empowerment and

teamwork.

Benefit of TQM• Eliminate defects or errors.• Reduces waste and quality cost.• Improves communication.• Provides opportunity for personal

growth.• Increase motivation and acceptance of

new ideas.• Increases Job Satisfaction.• Employee recognition.• Promotes teamwork.

Motivation through shared vision

Motivation through shared vision

Motivation through fear and loyalty

Motivation through fear and loyalty

Transforming an Organization

Attitude: “Its their problem”

Ownership of every problem affecting the

customer

Ownership of every problem affecting the

customer

Continuous Improvement

Attitude: “The way we’ve always

done it”

Attitude: “The way we’ve always

done it”

Decisions based on data

and facts

Decisions based on data

and facts

Decisions based on assumptions/ judgment calls

Decisions based on assumptions/ judgment calls

Transforming an Organization

Everything begins and ends

with management

 

Everything begins and ends with customer

Everything begins and ends with customer

Doing it right the first time

Crisis management and recovery

  “Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.”

- William A. Foster