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Article information:
To cite this document:
Satya P. Chattopadhyay Steven J. Szydlowski, (1999),"TQM implementation for competitive advantage in healthcare
delivery", Managing Service Quality: An International Journal, Vol. 9 Iss 2 pp. 96 - 101
Permanent link to this document:
http://dx.doi.org/10.1108/09604529910257984
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Introduction
Case studies
TQM implementation
for competitive
advantage in
healthcare delivery
The authors
Satya P. Chattopadhyay is an Associate Professor of
Marketing and Steven J. Szydlowski is a Master of
Health Administration candidate at the University of
Scranton, Scranton, Pennsylvania, USA.
Keywords
Community planning, Health care, TQM, USA
Abstract
An examination of total quality management implementation projects in the healthcare industry is reported.
Illustrations of the projects show how projects are predominantly managerial issues-oriented, rather than
emphasizing medical/clinical aspects. The issue of competition between healthcare and managerial perspectives is
raised. The five cases reported were undertaken as part of
a Community Excellence Initiative in north-eastern
Pennsylvania which aimed to make the region more
attractive to relocating business. Looks at implications of
the projects for the future.
96
during the day of the nursing staff was recorded to identify the reason why the call bell
response was unsatisfactory. The staff were
charting in medical records, giving showers,
or talking on the telephone. This often left
only one nurse on each nurses station at
certain times throughout the day. The variation was equally distributed throughout all
three shifts at the care center.
Process implementation
Nursing staff were tracked as to whether call
bells were answered in a timely manner,
maintaining facility operational standards
(which meets government regulations) to
improve quality. All breaks were scheduled to
maintain sufficient staff on each of the three
nurses stations. Staff were instructed to
answer the call bells when needed and delay
on the medical charting if necessary. Staff
assured residents needs were met before
giving them showers.
Monitoring
Call bell response time as perceived by
patients.
Problem identification
For approximately two months before this
survey was conducted, residents and family
members were complaining to administration
about the timeliness of responding to call bells
by the nursing staff. The policy for responding to call bells in the facility is five minutes
maximum. Not only was policy neglected, but
also quality of care suffered. Residents would
often wait for nurses to assist them with toilet,
ablutions, eating, etc. This was a major
concern for residents, family members,
administration, and staff.
Survey results
Administration conducted a response survey
by ringing selected resident call bells and
recording the exact time it took for nursing
staff to respond. The total number of team
monitoring checks conducted was 44. Of the
44 test rooms, eight of the nursing responses
were delinquent. This is a high rate for skilled
nursing care. The average response time for
negative responses was 11 minutes with a
median of 9.5 minutes. The exact shift time
Monitoring
Management of caloric intake of elderly
patients to avoid medical complications.
Problem identification
The nutritional needs of certain residents
were not met. Some residents were receiving
97
Description
This agency is funded by the federal government. The area has a large population of aging
veterans whose medical needs are met in a
large part through this facility.
Monitoring
Identifying and improving the patient medical
record handling by reducing the number of
errors in documentation of patient treatment
and service received.
Problem identification
Physicians as well as patients have complained
and expressed dissatisfaction with current
medical records system. Cases have been
reported where delays and errors in treatment
have occurred due to incomplete and/or
inaccurate documentation of patient medical
record. Such events have the potential of
putting patient safety in jeopardy.
Findings
Quality assurance personnel, members of the
nursing staff, and the facility dietitian
reviewed 20 resident medical charts to find
reasons for this deficiency. After reviewing the
medical charts, the participants discovered
that communication was the sole reason for
this problem. Nurses were documenting the
changes in residents conditions appropriately; however, the dietitian often did not review
the documentation until two or three days
after at the weekly interdisciplinary meeting.
For those days the dietary department
was sending the same food tray before the
condition change took place.
Findings
A cross-functional team of physicians, clinical
staff and administrative personnel was put
together to study the existing system of producing and maintaining medical records. The
group systematically implemented TQM
principles and tools to study the situation and
identified problem areas in the existing inputs
and processes. A control chart was used to
study the operating characteristics of the
system under stable conditions, providing
evidence of an unacceptable level of inaccuracies. The study of the inaccuracies revealed
that a high percentage of them were caused
when the service provider did not update the
patient record, even as they recorded the test
reports at the next scheduled appointment
after the tests were requested.
Process implementation
Information flow sheets were designed. On
the change in a residents condition, the
attending nurse would fill out the sheet (as
well as document in the medical record), drop
it in an interdepartmental communication
box, and the dietitian would pick them up.
Food trays are served with the appropriate
calorie intake for each resident.
Process implementation
The project improvement team, in the short
term, decided to dedicate a printer in the file
room to automatically print computer reports
for inclusion in patient records as they were
received from the laboratories. In the long
term, a search was initiated to locate a high
performance comprehensive software package
that would automate the receipt of test results
and subsequent updating of patient records,
producing hard copy reports on a real time or
batch mode at appropriate locations.
Organization
A multidisciplinary healthcare facility providing rehabilitation care to outpatients and
residents recovering from trauma, surgery and
other conditions.
Process implementation
The team, with support from the vice president operations introduced mandatory meetings of RPMS personnel on a bi-weekly basis
and preparation of advance assessment of
refurbishing needs of the patient room inventory on a regular cycle.
Description
The plant-engineering department of this
major rehabilitation care provider in northeastern USA describes its mission as: To
provide the patients, residents, clients, and
staff with a quality maintained facility at a
reasonable cost.
Monitoring
To improve the Room Preventive Maintenance System (RPMS), as measured by
man-hours to refurbish a room and the
number of defects after completion.
Problem identification
The physical plant upkeep at this facility has
been of a high standard in general, but time
constraints (fast turnaround of patient rooms)
have resulted in pushing back ongoing maintenance until a crisis level has been reached.
Assembling the required material and labor
and completing a thorough evaluation of the
rooms with subsequent restoration to acceptable standards has not happened consistently.
This has resulted in significant complaints
voiced by patients themselves and/or their
relatives and visitors.
Findings
A cross-functional team consisting of nursing
staff, mechanics, utility workers and the
director of engineering worked with a process
consultant to study and address the problem.
They defined the elements of the RPMS in
terms of process, material, equipment,
people, environment and information aids. A
comprehensive checklist of items was
Monitoring
Assessing elderly needs: Geriatrician services,
(May, 1998).
99
Problem identification
Scranton, PA, has the second-largest elderly
population in the country. The availability of a
specialized geriatrician is non-existent. There
are four board-certified physicians in geriatrics in this area; however, none of them
practice in this field. The health needs of the
elderly population are not being met at the
present time.
Findings
Epidemiological statistics prove that the
unavailability of health care services to a
population result in an unhealthy community. This leads to more serious health conditions which eventually increase health care
expenditures due to more emergency care
entries.
Process implementation
Members of the Area Agency on Aging wrote
for, and received a grant to hire a full-time,
salaried geriatrician to serve the elderly population. Once established, the geriatrician will
provide services only to individuals 65 years
of age or older.
Discussion of findings
The positive impact of engaging in total
quality management driven improvement of
quality in healthcare service delivery is
undeniable, as the above illustrations demonstrate. The through link to competitiveness
and wealth creation can be shown through the
Deming chain (Deming, 1986). The philosophy behind TQM is of a journey in continuous improvement rather than the achievement
of a terminal goal.
There are however concerns that have
been voiced as TQM implementation gains
ground in the healthcare industry. The overwhelming majority of improvement projects
documented are clearly being implemented in
the managerial/business aspects of the
industry and not in the quality of diagnostics,
100
References
Deming, W.E. (1986), Out of The Crisis, MIT Center for
Advanced Engineering Study, Cambridge, MA.
Farber, S.J. (1988), Perspectives in quality assurance and
technology assessment, Report of a Forum of the
Council on Healthcare Technology, Institute of
Medicine, National Academy Press.
101
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