Features of Ishikawa, Juran, and Deming with Respect to Quality Management - Assignment Example

Health Sciences and Medicine of Affiliation] Table of Contents Workbook activity 2 Features of Ishokawa, Juran and Deming with respect to quality management 2 Differences of the approaches from quality assurance and control initially used in industries 3 Key elements of the TPS and ways in which they are integrated 4 Respect for people 4 Continuous improvements 4 Possible reasons for failure of quality control by the Toyota Company 5 Health Care Quality 5 Quality improvement as an aspect of Health Service Management 6 Conditions for Quality Improvements 6 Workbook Activity 2 6 Adverse Events 6 Types of adverse events and why there are variations in the studies in the adverse events 7 Preventable and non-preventable adverse events 7 Examples of preventable errors in medical field 8 Examples of non-preventable medical errors 8 Workbook activity 3 8 Why adverse event causal factors identified as individual issues or systems 10 Reasons why problems were identified during the inquires and not via accreditation 11 Workbook activity 4 12 Blame Free Culture 12 Differences between blame culture and just culture and the importance of the distinction 12 Reasons why Berwick believes that traditional approaches to quality assurance and control contributes to the blame culture. 12 Reasons why doctors are likely to self-blame 13 Quality improvements and managements that require processes that require open or just culture to be effective 14 Workbook activity 5 15 Ways in which EBHC practice improves effectiveness in clinical field 15 Limitations and criticisms of EBM 15 The benefits and barriers to patient centered care (PCC) 16 The barriers of PCHC 16 Workbook activity 6 17 References 18 Mar, C., Bennett, S. & Hoffman, T. (2009). Evidence-Based Practice across the Health 18 Professions. Australia: Elsevier 18 McCutcheon, H & Courtney, M (2009). Using Evidence to Guide Nursing Practice. Australia: Elsevier 19 Murdough, C. & Person, M. (1994). Patient Centered Care: A Model for Restructuring 19 Australia: Jones & Bartlett Learning 19 Timmermans, S. & Mauks, A. (2005). The promises and pitfalls of evidence-based medicine. 19 Workbook activity 1 Features of Ishokawa, Juran and Deming with respect to quality management Ishakawa defined quality basing his argument on a broader and narrow perspective. He defined quality on a narrow perspective as quality of products and broadly defined quality basing his arguments on the following areas service, process, system, division, people, and finally company that include all the workers such as the managers and the other work force. The quality needs to be improved in an organization and he believes in the substitute quality characteristics (Davenport and Short, 1990). Deming believes that quality is considered based on customers satisfaction and the level of efficiency of management circles in the management process, project improvements, and final implementations. He argues that quality is set by companies on uniform basis and customers should depend on the quality standards set by the companies, which should never be compromised by any person. He believed in four main pillars of knowledge thus, Philosophical knowledge, Premise of knowledge, in depth variation knowledge, and System admiration. According to Juran, he believes that quality is the fitness of a substance for human use. He believes that product performance should meet the set standards to satisfy customers. He argues that quality should be examined and determined in order to identify the product fitness. Juran argues that quality of products can be managed through the following parameters thus, quality planning, quality control, and quality improvements. Juran believes so much on the principles of Pareto, which considers some of the factors as vital while others as trivial (Davenport and Short, 1990). Differences of the approaches from quality assurance and control initially used in industries The traditional approach to the quality control that was used in most of the industries does not really consider the processes that are involved in the production process but rather the final product. This means that all the production processes involved in the process may be inefficient. This may result into more funds being used in the production process and increase in time allocation for such projects. In addition, this could hinder products profitability and proficiency (Gao, Tsao and Wu, 2003). The approaches discussed above believe in the continuous improvements of product quality in every production process until the last stage of production. Continuous improvements involve people, management, and techniques that are involved in the process of production in order to achieve the needed overall quality development. Key elements of the TPS and ways in which they are integrated The key elements of the TPS are broadly categorized into the following areas thus, Respect for people Respect for people is categorized into two thus, Teamwork Teamwork results into growth in professionalism and personal growth. Teamwork helps to maximize on the general performance within an organization as well as improving the individual performance. Respect Respect is an important aspect in an organization. Respect among individuals helps build on trust and enhances individual responsibility. Continuous improvements Continuous improvements of products within an organization is further classified into sub areas that include, Improvement The organization should venture in much of innovations in order to improve on the quality of its products and services, which should be continuous throughout production processes. Challenge An organization should identify its challenges both long term and short term challenges and finds the amicable solutions through creativity. Genchi Genbutsu The organization should identify the root causes of their problems and find ways of fixing the problems with the main aim of improving their production processes. The above-discussed principles must be incorporated into the system as every person in every production stage plays a major role in the quality of the products produced and maintaining of the quality. Integration of all these principles increases the efficiency under which an organization operates. Possible reasons for failure of quality control by the Toyota Company Product quality control failure by the Toyota Company might have been attributed by the product onslaught in the year 2009-2010 by the Toyota Company that made the company employees exhausted (Shingo, 1989). The increased demand in production within sort time resulted into fatigue of the employees of the company and the company employees with regard to any malfunctioning part raised no alarm. For example in 2010, faulty pedals were issued with no alarm raised. These parts were then used and fixed on other vehicles. With the increase in production demand, the company did not hire more workers instead. This led to much pressure on the employees. Much of pressure results into less quality products. This was a factor, which the company might have avoided by staffing more workers and hiring employees that are more qualified. Health Care Quality Health care quality are the benefits that the employees of an organization are subjected to from the health services especially the ones measured by therapeutic results and diagnostic procedures. Health care quality may also mean that quality shows the extent by which health care services and the products may provide outcomes that are desired by the customers of the organization (IoM, Adams and Corrigan, 2003).  Quality improvement as an aspect of Health Service Management Quality improvement is considered an important aspect of health service management since it is a continuous process of product improvement t Quality improvement as an aspect of health service management that results into better products and health related services. Quality improvements can be achieved by finding product improvement opportunities. Obtaining data from the health centers helps to achieve product improvements through problem identifications and at the same time identifying possible opportunities that exist. Continuous product improvements in quality results into increase in the efficiencies, result into better service delivery, and minimize the costs involved (Johnson, 2011).  Conditions for Quality Improvements The conditions that are considered during improvements in quality depend entirely on the considerations in question. The factors under consideration may be when the service time has been extended than the expected time, when more resources have been used than was anticipated, when the cost of service exceeds the anticipated cost, and inefficiency in the service. It is the advisable to apply the quality improvement principles in all the production processes in order to achieve products of higher values using the least resources possible. Product quality improvements either can be external including such factors as security of the company or may be internal such as technology in information (Johnson, 2011). An organization must as well identify all the areas that require improvements and categorize them either as external factors or internal factors and finding amicable solutions on how to find them fixed. Workbook Activity 2 Adverse Events Adverse effects are hazards that arise from the health interventions and are responsible to the harm that occur to the individuals. The injuries ranges from time discharge disabilities to prolonged stay in the health centers as a result of injuries that occur in such centers, deaths and any other life threatening illness in the hospital. Adverse effects can be either preventable or unpreventable such as hospital medical errors and medical anomalies (Mason, Leavitt and Chaffee, 2012).  Types of adverse events and why there are variations in the studies in the adverse events There are two common types of adverse events, which include negligence, the medical errors, falls, and slips. The medical errors involve problems in drug infusion, wrong drug administration to patients, and wrong drug prescription. Some of the errors may be as result of inadequacies in facilities and wrong diagnostic procedures made by medical practitioners as a result of result misinterpretations, and wrong procedures of invasion. Adverse events can as well occur due to mismanagements in medical record keeping, which may be on wrong names on files and lose of patient records within the health centers (Mason, Leavitt and Chaffee, 2012).  Variations in the studies may be due to existence of numerous departments within health centers where a small error results into major aftermaths. In addition, the variations are as a result of hospitals in different regions having areas where adverse effects may occur. Adverse effects vary from one country to another depending of income level of the country, which depends on development level of the country and the general structure of the organization that involves in individual training and error reporting (Mason, Leavitt and Chaffee, 2012).  Preventable and non-preventable adverse events Some of the adverse events are preventable while some are unpreventable. The non-preventable adverse events are not within control of human beings. For example, infections of the surgical sites. A number of cases have been reported due to surgical operations even though there are well laid down policies for clean septic techniques. Leucopenia because of chemotherapy affects most of the patients. This shows that when patients are never provided with the chemotherapy, they are likely not to be prone to such infections. When these are observed, deaths will only occur due to other infections like cancer but not because of leucopenia (Bruce, Russell, Mollison and Krukowski, 2001). Examples of preventable errors in medical field Preventable medical errors include, Organ transplant, wrong medical administration, surgical site infections, pressure sores ulcers, deep venous thrombosis, traumas in the health centers, foreign bodies left after surgeries in patient bodies, and performing of wrong surgeries in patients for example, using wrong sites and performing surgeries on wrong patients Examples of non-preventable medical errors Non-preventable medical errors include, infections that occur as a result of chemotherapeutic drugs, drug -drug interactions, administering an antibiotic to a patient having no previous history on the allergy, studies have indicated that no drug is 100% effective in DVT prevention, not all the cases of aspiration are fully preventable (Bruce, Russell, Mollison and Krukowski, 2001). Workbook activity 3 Bundaberg In Queensland, most of the doctors are appointed depending on need. This poses a challenge as doctors undergo through different training processes. There were many inconsistencies as training of doctors locally was not the same as training of doctors internationally. The doctor’s credentials were not crosschecked by the surgeons’ college. Not all the specialists took part in the management of the clinical performance. Bristol Poor teamwork development Leadership failure and loss of direction in an organization Lack of better use of resources in a health center Lack of better techniques and methods in the audit process within an organization. Keeping some of the information secret such as audit information. Failures in management within an organization. Lack of better ways to monitor, report, and improve the organizations quality. Memorial hospital of kin Edward Insufficient documentations. For example, documentation that lack necessary information on continuity Inexperienced doctors were never supervised and were left to carry out some of the operations that were involving and needed better skills. Most of the individuals and departments within the organization did not coordinate well. Some of the clinical errors occurred due to failure to recognize conditions that were serious. Why adverse event causal factors identified as individual issues or systems The events can be classified as either individual issues or systems. This is simply because they show investigators whether there is need to make modifications in the whole system or in individual part of the system. The analysis can be made on a surgeon that performs an operation and has no enough skills to perform the exercise. Such a scenario may result into adverse effects on the patients undergoing through the operation. Such effects are classified under individual errors. Such individual errors may be minimized by having the individuals assessed by the college of surgeons and the medical council. The council after evaluation either recommends the individual for practice or further training. Proper systems of audit need to be put in place in health centers to help investigate on the adverse effects. For example, having multi resistant equipment in health centers that causes infections in various wards. It is therefore, necessary to check whether an infection occurred in the health center or in a community after a patient is administered (Bruce, Russell, Mollison and Krukowski, 2001). The community-acquired illnesses are less risky as compared to the ones acquired in the health centers. Correct septic techniques and guidelines are important parameters to consider when there are cases of multi resistant infections within health centers and all the employees should be involved. Such cases may be as a result of some sections of the hospital not well sterilized. This in general requires change in the whole system rather than change in individual. This shows the importance of classification for every problem involves different ways to fix the problems. Reasons why problems were identified during the inquires and not via accreditation Accreditation is a process that is given over a given period. Any was an inquiry set it could be that the accreditation process was performed well before the inquiry. Public inquiry usually results where there are serious of adverse outcomes with no particular feasible explanation. Health center that meets any conditions set by the accrediting body then they get the accreditation for a given number of years provided the standards are maintained. The accrediting body will never carry out any operation within the period of registration. Therefore, in case there was an inquiry set it could be that the accreditation process was performed well before the inquiry. Public inquiry usually results where there are serious of adverse outcomes with no particular feasible explanation. The process requires thorough investigations on the outcomes based on whether it is individual or system and recommendations are provided on ways to find the problems fixed. On the other side, accreditation involves the applications that are used to check is a health center or the hospital meets set out national standards and the processes. The process does not dig deep into the procedural details. Workbook activity 4 Blame Free Culture Blame free culture is an environment where errors are reported without fears of criticism. Such environments encourage risk takings and involves acceptance of responsibilities among individuals, which is an important aspect for learning. The belief that even skilled people make mistakes and we should learn our mistakes. (DeGrosky, 2007). Differences between blame culture and just culture and the importance of the distinction Just culture is a type of culture where the people who are involved are never punishable for the actions that they do, and for the decisions, they make so long as these actions are justifiable by their training and experience. In addition to this, there is no tolerance for any negligence and any deliberate violations of such obligations. The blame free culture is subjected to some flaws, which include; it finds it difficult to distinguish between acts that are non-culpable and the culpable actions and fails to tackle problems of individuals who willfully engage into acts that are not within the regulations of law. The just factor addresses these factors after thorough negotiations with the parties involved and set relevant boundaries, eliminates any chance to the occurrence of errors (Dekker, 2012).  Reasons why Berwick believes that traditional approaches to quality assurance and control contributes to the blame culture. The traditional approach to quality assurance and control stress more on ways of meeting the required standards than ways to improve the process standards. The approach assumes that the work place may develop some poor outcome with build tolerances. This factor promotes avoidable errors that might happen which should be overlooked for the errors can be fixed and new implementations made to fit the original processes. Quality assurance and quality control are processes that should never be treated as standards for they are ongoing processes. When standards are set, the workforce may strive to achieve such standards and might as well develop smug which promotes product satisfaction and the natural growth. Some of the set standards may be low and when they are followed without evaluation may cause damages. There may be no better sources of information available for the documented cases where standards are to be met. Lack of such information may result to lack of opportunity to learn about good practice. It is important to make sure when changes are implemented, though analysis are carried out to see the impacts of implemented changes on the organisation’s operation and not just part of the organization because the change may be useful to one of the departments but might not be of benefit to the other departments. As discussed above, it is worth to conclude that meeting standards alone might act as eye opener to individuals in the overall functionality of the organisation thence, when matters do not work well such environments then the employee’s might blame one another for its non-functionality. Reasons why doctors are likely to self-blame Doctors play key functions in an organization, as they are key decisions makers in patient’s healthcare. When anything goes wrong within a health care organization, doctors self-doubt themselves for the decisions they made. This may contribute to self-blame and shame among the doctors fraternity. Studies have indicated that as much as the mistakes can be minor, most of the practitioners often report some emotional reactions during times of duty. These include frustrations and anger among others. In as much as the physician involved may not be part of the vice that might be responsible for the problems because they do not discuss some of the problems with other practitioners and do not seek for proper advice. Physicians are encouraged to discuss their issues with other fellow practitioners and through this; they might find that some errors are non-preventable so that they do not feel shameful on their acts. When such errors occur and medical practitioners do not discuss these with their partners, it might negatively affect the practitioners’ mental state thence; there should be services available to physicians where they can discuss their feelings with their partners. Finally, studies in the medical field have indicated that when medical practitioners share their experiences with others they are made to understand that no human being is perfect and this increases the efficiency by which the mistakes are considered (Jacob, 1995). Quality improvements and managements that require processes that require open or just culture to be effective Quality improvement and management areas include reporting errors and disclosure of errors. Individuals are encouraged to be open-minded and free when reporting such errors within their areas of operation. Event reporting and incident reporting are considered non-punitive in the health care system of an organization. This phenomenon encourages reporting, identifies the organization’s problems, encourages teamwork, and finally, promotes learning among organization’s individuals. This area of professionalism is faced by a number of challenges, which include, humiliations. Better systems are needed to promote confidentiality and to report the errors. Another area to consider with regard to quality improvement would be ways in which errors are disclosed. Open communication and honesty among individuals such as health workers, physicians, and administrative staff in a work place is vital. On the other hand, there is a protest against open disclosure, as people believe that this may increase the frequency of claims and the costs might increase tremendously. The moment errors are never disclosed in work place, people may develop mistrust in the health care system and the moment health professionals do not provide answers to certain questions, the whole process may lead to malpractice claims. In a just culture workplace, every person is part of the system and feels accountable for maintaining the required organization’s standards and works hard towards the delivery of an outstanding care. These individuals believe that they may not become victims to the blames for any system error that may occur and feel safe raising concerns for there is no penalty for any error that occurs. Workbook activity 5 Ways in which EBHC practice improves effectiveness in clinical field EBHC is to reduce errors. Evidence based medicine may be termed as explicit, judicious, and conscientious way in which medicine is used. The practise involves use of a person’s clinical expertise in line with clinical evidence from the system. Some of the examples of EBP and clinical effectiveness are, Randomised control trial (RCT) that showed that treatment of steroids is quite useful in Bell’s Palsy, in 2010 research indicated that a simple blood test may be used for people with suspected bowel cancer, studies have showed that public health policies on smoking have saved many lives, the research showed that with the help of clinical trials and evidence-based practice, HIV is not a chronic disease and can be managed, and the genetic testing for intraocular melanoma is considered to be a very effective test and saves patients from going through the trouble of having unnecessary treatments. Based on the above analysis, it is worth noting and to appreciate that EBP is clinically quite effective, provides better outcome, cost efficient, saves resources, and less time consuming (Hout and Stalk, 1993). Limitations and criticisms of EBM Some of the limitations and criticism of evidence-based medicine include, The costs involved in RCT’s are high, the process involves a big gap between the time RCT’s is conducted, the application time, and the time in which results are published to the public, the effectiveness of a treat in a RCT and in routine clinical practice might be quite different because not all evidence from such RCT’s is made available to public and clinicians, racial minority groups have been under-researched and in such cases RCT is confined to the general concepts. Finally, hypo cognition hinders the application of EBM (Mar, Bennett & Hoffman, 2009). It is important to use EBM in conjunction with clinical experience and to make changes appropriately. Every medical practitioner must have consolidated mental framework where new information of EBM are safely put into use. The benefits and barriers to patient centered care (PCC) They are exempted in situations when a problem occurs because they were actively involved in the process. Research indicates that showing support results into positive health outcomes on patients, It involves engagements with the patient thence develops better rapport among individuals. The process results into increased efficiency and output level. Because it involves less processes of diagnostic tests and eliminates unnecessary referrals. The possibility of having medical errors is greatly reduced (Murdough and Person, 1994). The barriers of PCHC Some of the barriers to PCHC include, much time and costly due to the manpower required, there is professional power and the staff feel that their powers are being taken away from them, PCHC leads to lose of autonomy in the decision making process, there is no well defined clarity of what constitutes PCHC and therefore it is hard to explain and put into practice, to practice PCHC is difficult where there is barriers in communication (Murdough and Person, 1994). PCB has contributed to individual’s healthcare experiences. In some cultures, certain behaviors have been considered as normal while others are not. It is advisable to uphold people’s belief based on their cultural backgrounds and standards. For example, a female being who has always been examined by a female doctor might find it so difficult to be examined by a male doctor. It is mindful to consider persons from other communities where certain practices are practiced. For example, be careful when talking about female mutilation to persons from such backgrounds. Workbook activity 6 Improper ways in which people communication act as barriers to various developments. The organization tries hard to ensure that these communication channels easily reach the people they are intended for. The various channels of communication are needed to be consistent in all the departments. The health centers must adopt methods of duty delegation. All the medical practitioners are engaged in the duties within an organization like screening of patient and various research works. In order to achieve change in an organization, the top officials must ensure that all the staffs understand functionality of the system. Understanding systems functionalities within an organization makes it easy for other staff members to perform their duties with ease. Lack of necessary skills in an organization hinders the developments. It is advisable for practitioners to have the necessary skills to perform their tasks. Acquisition of necessary skills makes the practitioners feel competent during delegation of duties. Medical practitioners acquire skills through their routine training. Finally, the challenges to achieving successful change in an organization involve the use of redundant procedures in the implementation of change. Lack of proper communication and inadequate resources slows down the process of change (McCutcheon and Courtney, 2009). References Bruce, J., Russell, E. M., Mollison, J., & Krukowski, Z. H. (January 01, 2001). The measurement and monitoring of surgical adverse events. Health Technology Assessment (winchester, England), 5, 22, 1-194. Davenport, T.H. and J.E. Short. 1990. "The New Industrial Engineering: Information Technology & Business Process Redesign". Sloan Management Review, pp. 11-27. DeGrosky M. Can a “Just Culture” Save Us? Wildfire. 2007 March/April [p 8-9]. Dekker, S. 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(2012). Policy & politics in nursing and health care. St. Louis, Mo: Elsevier/Saunders. McCutcheon, H & Courtney, M (2009). Using Evidence to Guide Nursing Practice. Australia: Elsevier Murdough, C. & Person, M. (1994). Patient Centered Care: A Model for Restructuring Australia: Jones & Bartlett Learning Timmermans, S. & Mauks, A. (2005). The promises and pitfalls of evidence-based medicine. Shingo, S. (1989). A study of the Toyota production system: From an Industrial Engineering View point: Productivity Press. Read More