The effectiveness of Total Quality Management and Continuous Quality Improvement in the Healthcare setting - Research Paper Example

The Effectiveness of Total Quality Management in the Healthcare Setting Abstract This paper compares five different articles about the use of Total Quality Management (TQM) and Continuous Quality Improvement (CQI) in the healthcare environment. Results were examined from the readings of papers from Korea, the United States, Norway, Sweden, Saudi Arabia, and the World Health Organization. The articles report much the same results with the exception of the Korean Hospitals; Lee (2002) reported the most commitment and utilization of Total Quality Management principles on a long-term basis. Øvretveit (2003) suggested that hospitals need to commit more management to the Total Quality Management policies. Zbaracki (1988) listed the various ways that implementation of TQM could side-tracked or misconstrued. Bigelow (1995) concluded that Total Quality Management as a success for hospitals and healthcare institutions is yet to be determined as there is very little published documenting specific instances. Keywords: Total Quality Management, Continuous Quality Improvement The Effectiveness of Total Quality Management in the Healthcare Setting As the health care industry continues to meet the challenges of escalating costs, high turnover in personnel, and continuing customer service complaints, healthcare has turned to Total Quality Management to address the issues and implement solutions. Total Quality Management (TQM), also called Continuous Quality Improvement (CQI), has been utilized to assess efficiency, quality of care, cost-effectiveness and safety issues. In this paper I will address concrete examples of implementation of Total Quality Management at various international hospitals, and discuss the results of the findings from these published journal articles. I will assess the success of these programs and their lasting value in the determined workplace. I will list the detrimental factors in the implementation of TQM, and the causes for negative results. I will conclude with an evaluation of the measured results of Total Quality Management within the healthcare industry. Swedish hospitals employed TQM and CQI when confronted with avoidable patient injuries, wastefulness of health care resources, and public criticism of health care management and quality of care (Øvretveit , 2003, 6). Their use of Total Quality Management resulted in mixed reviews. Øvretveit noted the obstacles of costs and time constraints, especially on physicians’ time, that limited the comprehensive use of TQM (11). Notice was made regarding the hierarchies indwelling in hospital social strata, that of both the physicians and the nurses, and the disregard of management to institute real change. TQM teams were set up, but the meetings were reduced as more pressing factors (patient emergencies) limited the meeting times and the efficacy of the process. Often decisions impacting patient care bypassed the TQM process for a quicker resolution to an immediate issue. The Korean Hospitals have been most successful at implementing TQM as they have built in a TQM or CQI department from the beginning. Rather than making TQM a secondary model for management, the Korean hospitals have embraced TQM as their total problem-solving solution. This resulted in Korean hospitals having created and managed TQM programs in 72% of their hospitals (Lee, 384). The major impact of this study determined that the climate of organizational change and the implementation of statistical data were the primary factors in the successful use of TQM and CQI (Lee, 391). Unfortunately, the openness to institutional change and the collection of statistical data were two of the most common issues reported as detrimental to change. Zbaracki (1988), in his article, “The Rhetoric and Reality of Total Quality Management,” states there are several places that the TQM implementation can go off track. The hospital setting has its peculiarities of relationship issues because of the hierarchy between the doctors and the staff, resulting in less than optimal results. Zbaracki says the following junctions are opportunities for divergent aspects: Ignorance- management implements TQM and starts the information flow (618), Intimidation-management stresses the importance of TQM, employees follow (619), Integration-there is a lack of integration with the existing structure of management (620), Retention-once TQM is used as a tool it is often “tossed away” for the newest management theory (624-625), Return- beginning the cycle again-at this point the original teams of TQM begin to describe and teach the event to other groups. The hospital was successful in teaching satellite hospitals how to use TQM and became a model for other organizations (627). Employee turnover is a detriment to the success of TQM (629). Øvretveit and Gustafson report similar results in their report, “Evaluation of quality improvement programmes.” The most commonlyreported [complaints] are senior management commitment,sustained attention [to the programme]and the right type ofmanagement roles at different levels, a continuing focus oncustomer needs, physician involvement, sufficientresources, careful programme management, practicaland relevant training which personnel canuse immediately, and the right culture (270). Regardless of which hospital system or healthcare provider, the commonalities between the systems demonstrate the importance of commitment to the Total Quality Management program by management, physicians, nursing and staff. Using TQM as a Band-Aid or stopgap in a temporary manner resulted in a mixed effort and a confused staff. The hospitals that gave credence to the TQM teams and provided resources and training were the most successful, according to Øvretveit (270). The Korean hospitals were the most successful of all. The use of Total Quality Management in a healthcare system has not been determined to be an effective management tool. Bigelow (1995) stated that, “very little data exist confirming the claims made onbehalf of TQM, including improved performance, quality or competitiveness…Thereis a noticeable lack of evidence that hospitals are able to create systematic change through theorganization, or that they are able to sustain such change or benefits over time (15).” It is not known if the negative outcomes are a real phenomenon, or if hospitals are not reporting the success stories in publications and journals. Because of the time constraints in documentation and publication, it might be assumed that the hospital personnel are focusing on the publication of medical research results and less on management issues. Lack of statistical evidence implies that the hospitals use the statistical methods less in the utilization of Total Quality Management, which echoes the results of the data reported by Lee (2002). Other factors to consider are the need for studies that give a step by step guide to successful implementation of Total Quality Management within the hospital setting. Research is lacking in this arena, which may change the entire picture of the effectiveness of TQM and CQI in the healthcare field. References Bigelow B, Arndt M (1995). Total quality management: Field of dreams? Health Care Management Review, Vol.20, No.4, (15-25). Print. Lee, S., Choi, K., Kang, H., Cho, W. & Yoo, M. C. (2002). Assessing the factors influencing Continuousquality improvement implementation: experience in Korean hospitals. International Journal for Quality Healthcare, Vol. 14, No. 5, (383-391). Print. Øvretveit, J. and Gustafson, D. (2002). Evaluation of quality improvement programmes. Quality andSafety in Healthcare, 11, 270-275. Print. Øvretveit, J. (2003). What are the best strategies for ensuring quality in hospitals?WHO Regional Officefor Europe’s Health Evidence Network (HEN)November 2003. Print. Zbaracki, M. J. (1988). The Rhetoric and Reality of Total Quality Management. Administrative ScienceQuarterly, Vol. 43. No. 3. (9/1988), 602-636. Retrieved from: http://links.jstor.org/sici?sici=0001- 392%28199809%2943%3A3%3C602%3ATRAROT%3E2.0.CO%3B2-P Read More