Critical relationship between an organization (of a hospital) and a physician

Physicians may be reluctant for total quality management systems due to concerns that sensitive patient-physician relationships might be affected. The main reason is the fact that total quality management implies “standards”. However, according to the physicians every patient and medical case implies a distinct process and they can not be standardized. Thus quality management may restrict the resources allocated for patient care.

It is very important that those leaders that want to implement a total quality management model should clearly demonstrate and prove that total quality management is not an audit or control mechanism but it is a system that helps to investigate root causes of problems and find their solution methods.

Quality management team plan used at Michigan University Medical Center

1)      Define the process

2)      Arrange the data

3)      Analyze the root causes

4)      Determine alternative solutions

5)      Measure the change for solution

6)      Apply the alternative

7)      Plan for the future

Committees for quality assessment in hospital services

a)      Committee for medical review

b)      Board of directors

The number of committees in a hospital may change according to the size, capacity and staff of the hospitals.

Healthcare organization committees for the administrative services

a)      Committee for monitoring medical records

b)      Executive committee

c)      Qualification committee

d)     Security committee

e)      Committee for the systems

f)       Usage committee 

g)      Meeting committee

Healthcare organization committees for the medical services

a)      Committee for the quality improvement of medical staff

b)      Committee for the quality improvement of nursing services

c)      Committee for the inspection surgical cases

d)     Infection control committee

e)      Tissue committee

f)       Committee for the medicine administration

g)      Committee for the evaluation of blood use

h)      Clinical meetings committee

Important steps for restructuring the healthcare services

1)      Abandoning the processes that do not add value

2)      New services that add value for the patients and physicians should be added

3)      Continuity of the care should be maintained

4)      Clinical care should be strengthened

The difference between positive and negative organizational cultures

In positive organizational cultures employees are proud of to be a part of the organization and they can devote themselves for continuous quality improvement. They will help each other to meet the targets and they will enjoy the process. In this kind of organizational culture employees will feel that they can add value to the organization and processes and their ideas and opinions are important for the whole organization. Positive thinking is considered as the main energy source of the organization. Employees can envision new opportunities and are open for change. They believe that they can solve their own problems and they can take risks for improvement and learning.

On the other hand, in negative organizational cultures employees will prefer to defend themselves and they will spend their energy to confront each other. They will refrain from taking risks in fear of punishment. They will resist change and will try to maintain status quo.

Main process for organizational culture in healthcare services

1)      Top management meeting

2)      Formulation and modification of organizational philosophy

3)      Establishing customer and human resources task units

4)      Spreading the organizational philosophy

5)      Reflecting the philosophy in the daily routine actions

6)      Determining the culture gap via data gathering

7)      Data feedback

8)      Establishing the customer and human resources action teams

9)      Developing primary action items and programs

10)  Implementation of the program

11)  Behaviour model of the key staff

12)  Evaluation and feedback for determining the culture gap

13)  Determination and modification of the human resources system

14)  Determination and modification of other essential systems

15)  Evaluation and feedback for determining the culture gap

Organizational Culture

One of the main pillars of total quality management is the proper integration of employees with the system. The major accomplishment in organizational transformation is to eliminate the unconsciousness and to include everybody in the change process. This will enable the organization to establish new efficient forms. The key parts of an organizational culture are the norms. Norms can be considered as the unwritten rules and regulations that explain how employees should behave in an organization. On the other hand, values are the assurances that explain which results should be achieved and preferred.

Leadership qualifications for organizational transformation

1)      A proper vision

2)      Social responsibility

3)      Managing ambiguous situations

4)      Handling change

5)      Getting along with people

6)      Sharing information

7)      Interaction with customer values

8)      Dedication for improvement and change

9)      Raising awareness

10)   Dedication for education and training

11)   Willingness to give responsibility to subordinates

12)   Good relationships with suppliers and vendors

13)   To know oneself

14)   Ability for creative thinking

15)   Willingness to take risks

Leaders of healthcare organizations should answer the following questions in order to develop a new vision

1)      How should our organization look like? 

2)      Will customers like the organization when the vision is implemented? 

3)      Which are the most important values for us?
  
4)      Will the vision meet all our important values and customers’ interests? 

5)      Where will everybody be located in the future vision?

Key elements for implementing a successful total quality management system

1)      Customer oriented vision 

2)      Capacity for change 

3)      Reaching the threshold for change

4)     Making plan for change

Customer oriented continuous quality improvement philosophy

Key elements of customer oriented continuous quality improvement philosophy are summarized in Edward Deming’s plan that includes 14 items:

1)      Being devoted to the main goal for improving the product and service.

2)      Developing new approaches.

3)      Abandon putting blame on someone in order to obtain quality.

4)      Accentuate fidelity and trust.

5)  Continue to develop product and service system in order to improve quality and   productivity.

6)      Adopt on the job training.

7)      Adopt leadership. Audit should only aim for helping the employees.

8)      Avoid anxiety and fear at the work place.

9)      Remove the barriers between departments.

10)   Instead of advising the employees, demand new levels of productivity from them.

11)   Do not impose the amount of work.

12)   Remove any obstacles that might hamper the pride of employees.

13)   Encourage training and self-improvement.

 

14)  Encourage everyone in the organization to work for transformation.

Definition and key elements of quality in healthcare

According to the definition of Joint Committee of Accreditation of Healthcare Organizations (JCAHO), quality in healthcare means “increasing the possibility of obtaining expected results and reducing the risk of unexpected results based on the most current knowledge”.  Quality in healthcare can be analyzed in two different ways:

1)      Technical Quality : Can be assessed by medical doctors

2)      Service Quality:  Patients and their companions can comment on the quality

According to studies conducted on healthcare quality, the most important issue that patients and their companions pay attention is the respect to personal feelings. For more information on related studies please contact me at mahmutcemsunar@gmail.com .

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The initiative for quality improvement in healthcare facilities

A hospital can be considered as a temporary guest house for people that seek medical treatment. These people come from different social, economic and cultural backgrounds and therefore they all have quite different expectations and demands. The challenging task of offering a high quality healthcare service to those people depends not only on technology and knowledge but also on quality service.

Obviously quality requires a certain level of cost, however the implementation of quality management principles and scientific methods can help reduce quality related costs. The financial resources allocated for healthcare services remain uder pressure both in developed and emerging countries, therefore the only way to control costs remains to be “continuous quality improvement” initiative.

Giving quality healthcare service in a hospital to people that have different life styles, behaviours, habits and social backgrounds, remains to be a big challenge and brings out problems. Although rules and regulations may limit the flexibility of quality management teams, a structural transformation for quality improvement is still possible by good leadership and committed management.

Total Quality Management for healthcare facilities

The essence of “quality” concept in the healthcare sector arises from the fact that there is not only one type of patient and one type of treatment method. In fact, individual medical problems and patients vastly differ from each other and this makes the task of offering a standard healthcare service a challenging one. The term “standard” puts emphasis on quality and its indicators.

The input of the healthcare sector are patients (guests of healthcare facilities) that have unique characteristics and needs which require unique treatment methods. The healthcare services that are being offered with limited resources should be of excellent quality. Such a challenging task definitely requires a quality management plan that will look more complex than many other sectors. A well designed quality management plan will only start with a “commitment to quality” adopted by all parties involved in the healthcare services.