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.