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)

Thank you