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