Total Quality Management PDF

TOTAL QUALITY MANAGEMENT BY: Dr.Taghreed Hussien Leadership & Management Lecturer, NBU 1  QUANTIFIABLE SYSTEMS Measure performance TQM against set...

TOTAL QUALITY MANAGEMENT BY: Dr.Taghreed Hussien Leadership & Management Lecturer, NBU 1  QUANTIFIABLE SYSTEMS Measure performance TQM against set standards. LEAN CQI SIGMA Goal: Is to improve the quality of health care. SIX SIGMA DMAIC  What is TQM? Total Quality Management: ◼ Meeting quality expectations as defined by the customer ◼ Integrated organizational effort designed to improve quality of processes at every business level 3 Defining Quality – 5 Ways ◼ Conformance to specifications ◼ Does the product/service meet targets and tolerances defined by designers? ◼ Fitness for use ◼ Evaluate performance for intended use ◼ Value for price paid ◼ Evaluation of usefulness vs. price paid ◼ Support services ◼ Quality of support after sale ◼ Psychological ◼ e.g. Ambiance, prestige, friendly staff 4  Competing on Quality? ◼ High performance design: ◼ Superior features, high durability, & excellent customer service ◼ Product & service consistency : ◼ Meets design specifications ◼ Close tolerances ◼ Error-free delivery 5  TQM Characteristics Four (4) core characteristics of total quality management are: I. Customer/client focus II. Total organizational involvement III. Use of quality tools and statistics for measurement IV. Key processes for improvement identified 6 I. Customer/Client Focus - Internal customers: ◼ laboratory, admitting office, and environmental services - External customers: ◼ visitors, physicians, managed care organizations, insurance companies, and regulatory agencies. 7 II. Total organizational involvement Goal of total quality management: ◼ is to involve all employees and empower them with the responsibility to make a difference in the quality of service they provide. 8 III. Use of Quality Tools and Statistics for Measurement. ◼ tools, formats, and designs that can be used to build knowledge, make decisions, and improve quality 9 IV. Identification of Key Processes for Improvement. ◼ 1. Systems related (e.g., admitting, discharging, and transferring patients). ◼ 2. Clinical (e.g., administering medications, managing pain). ◼ 3. Managerial (e.g., risk management and performance evaluations. 10  Manufacturing Quality vs. Service Quality ◼ Manufacturing quality focuses on tangible product features ◼ Conformance, performance, reliability, features, durability, serviceability ◼ Service organizations produce intangible products that must be experienced ◼ Quality is often defined by perceptional factors like responsiveness, courtesy, friendliness, promptness, waiting time, consistency 11 TQM Philosophy – What’s Different? ◼ Focus on Customer ◼ Identify and meet customer needs ◼ Stay tuned to changing needs, e.g. fashion styles ◼ Continuous Improvement ◼ Continuous learning and problem-solving, e.g. Kaizen, 6 sigma ◼ Quality at the Source ◼ Prevention & problem-solving vs. inspection ◼ Employee Empowerment ◼ Empower all employees; external and internal customers 12 TQM Philosophy– What’s Different? (continued) ◼ Understanding Quality Tools ◼ Ongoing training on analysis, assessment, and correction, & implementation tools ◼ Team Approach ◼ Teams formed around processes – 8 to 10 people ◼ Meet weekly to analyze and solve problems ◼ Benchmarking ◼ Studying practices at “best in class” companies ◼ Managing Supplier Quality ◼ Certifying suppliers vs. receiving inspection 13  CONTINUOUS QUALITY IMPROVEMENT (CQI) (CQI) is used to improve quality and performance). Four major players in the CQI process: 1. Resource group made up of senior management (e.g., CEO, vice presidents 2. Coordinator-often appointed by the CEO to provide day-to-day management of the CQI process and related activities (e.g., training programs 14 CONTINUOUS QUALITY IMPROVEMENT (CQI) 3. Team leader-organizes team meetings, sets the agenda, and guides the group through the discussion 4. Team -designated to evaluate and improve select processes. 15  Components of Quality Management The quality management plan is a systematic method to design, measure, assess, and improve organizational performance. Components: 1. Set standards for benchmarking. Benchmarking- evaluate (something) by comparison with a standard. Standards are written statements that define a level of performance or a set of conditions determined to be acceptable by some authorities. 16 Three major dimensions of quality care (Standards ): a. Structure- physical environment, organization, and management- b. Process- connected with the actual delivery of care c. Outcome- involve the end results of care that has been given 17 2. Performance appraisals. ◼ Based on requirements of the job, employees are evaluated on their performance 3. A focus on intra-disciplinary assessment and improvement. ◼ a need for groups to assess, analyze, and improve their own performance. 18 4. A focus on interdisciplinary assessment and improvement. ◼ Multidisciplinary, patient focused teamwork emphasizing collaboration, communication, coordination, and integration of care 19  TOOL of Quality Management 1. SIX SIGMA ◼ is another quality management program that uses, primarily quantitative data to monitor progress. ◼ Six Sigma is a measure, a goal, and a system of management ◼ Six Sigma involves management to a greater extent in monitoring performance and ensuring favorable results. 20  2. LEAN SIX SIGMA ◼ Focuses on improving process flow and eliminating waste. ◼ Waste occurs when the organization provides more resources than are required. 21  3. DMAIC METHOD ◼ DMAIC is a Six-Sigma process improvement method. Steps in the method are: Define what measures will indicate success Measure baseline performance Analyze results Improve performance Control and sustain performance (DMAIC Tools: Six Sigma Training Tools, 2011) 22  Improving the Quality of Care 1. National Initiatives ◼ The National Quality Forum is a nonprofit organization that strives to improve the quality of health care by building consensus on performance goals and standards for measuring and reporting them (National Quality Forum, 2011). 23 Their goals are: No needless deaths No needless pain or suffering No helplessness in those served or serving No unwanted waiting No waste 24 2. Evidence-Based Practice ◼ Evidence-based practice (EBP) suggests that using research to decide on clinical treatments would improve quality of care, and that might be the case. Electronic Medical Records ◼ electronic medical records (EMR) should do so as well. Instant access to identical records should improve accuracy and speed communication among care providers Dashboards ◼ Dashboards are electronic tools that can provide real-time data or retrospective data, known as a scorecard. 25  3.Nurse Staffing ◼ Evidence is growing that increased nurse staffing results in better patient outcomes Reducing Medication Errors ◼ Ever since Medicare discontinued payment for hospital- based errors, pressure has increased for hospitals to prevent costly errors Peer Review ◼ Peer review can be used to identify clinical standards of practice that improve the quality of care. 26  Six Aims for Improving Quality in Health Care ◼ Safe ◼ Effective: Providing services based on scientific knowledge ◼ Patient-centered ◼ Timely: Reducing waits and sometimes harmful delays ◼ Efficient: Avoiding waste ◼ Equitable: Providing care that does not vary in quality 27  Risk Management is a component of quality management, ◼ Purpose: 1. is to identify, analyze, and evaluate risks and then to develop a plan. 2. Identifies potential risks for accident, injury, or financial loss 3. Analyzes the frequency, severity, and causes of general categories and specific types of incidents causing injury 28 4. Reviews and appraises safety and risk aspects of patient care procedures 5. Monitors laws and codes related to patient safety, consent, and care. 6. Eliminates or reduces risks as much as possible 7. Reviews the work of other committees to determine potential liability and recommend prevention or corrective action. 29 8. Identifies needs for patient, family, and personnel education 9. Evaluates the results of a risk management program. 10. Provides periodic reports to administration, medical staff, and the board of directors. 30  Nursing’s Role in Risk Management Five general categories: Medication errors Complications from diagnostic or treatment procedures Falls Patient or family dissatisfaction with care Refusal of treatment or refusal to sign consent for treatment 31 Incident Reports ◼ Accurate and comprehensive reporting on both the patient’s chart and in the incident report. ◼ Reporting incidents involves the following steps: 1. Discovery. Nurses, physicians, patients, families, or any employee or volunteer may report actual or potential risk. 2. Notification. The risk manager receives the completed incident form within 24 hours after the incident. 32 3. Investigation. The risk manager or representative investigates the incident immediately. 4. Consultation. The risk manager consults with the referring physician, risk management committee member. 5. Action. The risk manager should clarify any misinformation to the patient or family, explaining exactly what happened. 6. Recording. The risk manager should be sure that all records, including incident reports, follow-up, and actions taken. 33 Root Cause Analysis is a method to work backwards through an event to examine every action that led to the error or event that occurred. ◼ Patient—what patient factors contributed to the event? ◼ Personnel—what personnel actions contributed to the event? 34 ◼ Policies—are there policies for this type of event? ◼ Procedures—are there standard procedures for this type of event? ◼ Place—did the workplace environment contribute to the event? ◼ Politics—did institutional or outside politics play a role in the event? (Weiss, 2009) 35  Role of the Nurse Manager Important factors in successful risk management are: ◼ Recognition of the incident ◼ Quick follow-up and action ◼ Personal contact ◼ Immediate restitution (where appropriate) 36  Ways of Improving Quality 1. Plan-Do-Study-Act Cycle (PDSA) ◼ Also called the Deming Wheel after originator ◼ Circular, never ending problem solving process 2. Seven Tools of Quality Control ◼ Tools typically taught to problem solving teams 37  PDSA Details-Cycle is repeated ◼ Plan ◼ Evaluate current process ◼ Collect procedures, data, identify problems ◼ Develop an improvement plan, performance objectives ◼ Do ◼ Implement the plan – trial basis ◼ Study ◼ Collect data and evaluate against objectives ◼ Act ◼ Communicate the results from trial ◼ If successful, implement new process 38  Seven Problem Solving Tools ◼ Cause-and-Effect Diagrams ◼ Flowcharts ◼ Checklists ◼ Control Charts ◼ Scatter Diagrams ◼ Pareto Analysis ◼ Histograms 39 Cause-and-Effect Diagrams ◼ Called Fishbone Diagram ◼ Focused on identifying the causes of quality problem 40  Flowcharts ◼ Used to document the detailed steps in a process 41  Checklist ◼ Simple data check-off sheet designed to identify type of quality problems at each work station; per shift, per machine, per operator 42  Control Charts ◼ Important tool used in Statistical Process Control 43 Scatter Diagrams ◼ A graph that shows how two variables are related to one another 44  Pareto Analysis ◼ Often called the 80-20 Rule ◼ Principle is that quality problems are the result of only a few problems e.g. 80% of the problems caused by 20% of causes 45  Histograms ◼ A chart that shows the frequency distribution of observed values of a variable like service time at a bank drive-up window 46 Why TQM Efforts Fail ◼ Lack of a genuine quality culture ◼ Lack of top management support and commitment ◼ Over- and under-reliance on methods 47 ◼ thanks lettylopez2019