Dr.
Ramy Adel
Healthcare and hospital management consultant
Quality management consultant
Organizational development consultant
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WHY THEY HAD
SUCCEED?
WHY WE DID NOT?
WHAT ARE THE PROBLEMS????
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Exhibit 2–6 The Organization as an Open System
2–3
•WHAT IS
QUALITY ?
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WHAT IS QUALITY??
ANY
DIMENSIONS:-
USEFUL DEFINITION OF QUALITY MUST INCORPORATE THESE TWO
1- SERVICES FEATURES (( PRODUCT INCLUDE BOTH GOODS & SERVICES
2-FREEDOM FROM DEFICIENCIES.
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WHAT IS QUALITY??
• There are many short definitions :-
• Fitness for use
• Meeting customer expectations.
• Doing the right things right.
ANY USEFUL DEFINITION OF QUALITY MUST INCORPORATE THESE
TWO DIMENSIONS:-
1- SERVICES FEATURES
2-FREEDOM FROM DEFICIENCIES.
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WHAT IS QUALITY??
The proper performance (according to
standards) of interventions that are known to be
safe ,affordable to the society and have the
ability to produce an impact on morbidity ,
mortality , disability and malnutrition
(WHO 1988)
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WHAT IS QUALITY??
Freedom from deficiencies and product features
(fitness for use )
Mean absence of avoidable error or
unnecessary step in the intervention required to
achieve an equivalent out comes
(juran 1989)
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WHAT IS QUALITY??
Deficiencies
are costly to health organization. They waste time
and resources and must be identified and
corrected.
Features:
in healthcare means services that attract and satisfy
patients and distinguish one practitioner or
organization from others (e.g., pleasant waiting
area, computerized health record and care
management/care coordination).
(juran 1989)
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WHAT IS QUALITY??
Doing the right things right in the first
time every time
(Brown 2001)
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EFFECTIVENESS
Selecting the proper goals & achieving them
. “ Doing Right Things ”
EFFICIENCY
Mobilising the available resources ( human &
non human ) in the optimum way to achieve
the desired selected goals .
“ Doing Things Right ”
QUALITY
Doing right things right , First Time .
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Examples Of service Features
• Private hospital room
• Itemized hospital bill
• Short stay surgery
• Home Care Services
• Laparoscopic Surgery
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Examples Of Deficiencies
• Delay in admission
• Overcharged for
supplies received
• Surgery start late
• Meals delivered cold.
• Patient charged for
items not used
• Unplanned return to
surgery 13
WHO ARE THE CUSTOMERS?
• Customers are all those
affected by our work:-
• External Customers
• Internal Customers 14
Types of Customers
Internal customers : External customers :
any one inside the any one deal with the
organization organization from outside
>patient >patient
>workers >suppliers
>physician >providers
>nurses >3rd party
>administration >payers
Etc,,, Etc..
Quality Dimensions
Remember ( STEEEP ) in healthcare
According to IOM (institute of medicine )
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Quality dimensions
1:SAFETY :
▪ The degree to which the organization
environment is free from hazard.
▪ It is concerned with minimizing risks of adverse
outcome for both customer and provider as a
result of process intervention.
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Quality dimensions
[Link]:
The degree to which needed care and services
are provided to the customer at the most
beneficial or necessary time
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Quality dimensions
3. Effectiveness :
The degree to which care is provided in correct
manner to achieve the desired outcomes
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Quality dimensions
[Link]:
Efficient services provides the greatest benefit
within the resources available
It is the relation between outcomes and the
resources used to deliver service
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Quality dimensions
5:Equitable :
Provide care that does not vary in quality
because of gender , race , nationality ,
socioeconomic or status of religious
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Quality dimensions
6: Patient centered :
Provide care that is respectful and responsive to
the patient , needs ,values and preferences
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Quality dimensions
[Link]: .
The power of a procedure or treatment to
improve health status, as already shown
through scientific research (evidence based)
findings.
▪ e.g.: new drug , protocol
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Quality dimensions
8 . Appropriateness :
. The degree to which the care/intervention
patient’s clinical needs, given the current state
of knowledge.
▪ It is concerned with doing the right things in
accordance with the purpose.
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Quality dimensions
9. Access to service ( Availability ) :
The degree to which appropriate care /
intervention is obtainable to meet the
customer`s needs
Unrestricted services
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Quality dimensions
[Link]:
It means that the client receive the complete
range of services that he or she need without
interruption ,unnecessary repetition of
procedures
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Quality dimensions
[Link] and caring :
▪ The degree to which customers are involved in
the decision and the provider’s reaction in
meantime to the customer needs and
expectations.
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Total Quality Management in Health
Care
TQM succeeds because it leads to:
delighted customers
increased revenue
empowered employees
reduced costs
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Three Quality Management Processes
The 3 Quality Management Processes are
interrelated ,each one providing a structured
method for achieving specific quality
Objectives
1- Quality Planning.
2- Quality Improvement.
3- Quality Control.
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Quality Planning
1- Designs New Services.
2-it Ensure That The Right Set Of Services
Features Is Delivered To The Appropriate
Customers
3- Services Deficiencies Are Kept To A
Minimum.
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Quality planning
Quality Planning may also
be used to Redesign
existing goods and services
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Quality Planning
Verify goal
Measure .
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Quality Planning
Verify goal
Identify Customers
Measure .
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Quality Planning
Verify goal
Identify Customers
Determine customer needs
Measure .
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Quality Planning
Verify goal
Identify Customers
Determine customer needs
Measure .
Develop product
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Quality Planning
Verify goal
Identify Customers
Determine customer needs
Measure .
Develop service
Develop process
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Quality Planning
Verify goal
Identify Customers
Determine customer needs
Measure .
Develop service
Develop process
Transfer to operations 37
As the model for quality planning
shows, measurement is crucial at each
step of the process. From the very
beginning, it is essential to establish
ways to measure goals, customers,
customer needs, product features, and
finally, quality control, once the
project is transferred to operations.
Following these structured steps helps
to ensure that a quality planning
project meets a specific goal
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Quality Improvement
Quality improvement
Reduces Deficiencies in
Existing Services, or
processes.
Reaching this new level of
performance is frequently
referred to as breakthrough.
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EXAMPLES
Q. IMPROVEMENT PROJECTS
1- Reduce The Number Of
Postoperative Wound
Infections.
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EXAMPLES
Q. IMPROVEMENT PROJECTS
3-increase Utilization Of
Operating Rooms.
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EXAMPLES
Q. IMPROVEMENT PROJECTS
4- Shorten Waiting Times For
Outpatient Services
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Identify A Project
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Identify A Project
Establish The Project
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Identify A Project
Establish The Project
Diagnose The Cause
.
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Identify A Project
Establish The Project
Diagnose The Cause
.
Remedy The Cause
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Identify A Project
Establish The Project
Diagnose The Cause
.
Remedy The Cause
Hold The Gains
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Identify A Project
Establish The Project
Diagnose The Cause
.
Remedy The Cause
Hold The Gains
Replicate Results &
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Nominate New Projects
Quality Control
Q. Control
Ensures That The
Results Of The
First Two
Processes Are
Sustained Over
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[Link] Relies On A Feedback Loop
,Which Can Be Described As Follow
Establish
standards
FREEDBACK
LOOP
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[Link] Relies On A Feedback Loop
,Which Can Be Described As Follow
Measure
Actual
Performance Establish
standards
FREEDBACK
LOOP
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[Link] Relies On A Feedback Loop
,Which Can Be Described As Follow
Measure
Actual compare
Performance
To Establish
standard standards
FREEDBACK
LOOP
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[Link] Relies On A Feedback Loop
,Which Can Be Described As Follow
Measure
Actual compare
Performance
To Establish
standard standards
OK
FREEDBACK
LOOP
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[Link] Relies On A Feedback Loop
,Which Can Be Described As Follow
Measure
Actual compare
Performance
To Establish
standard standards
OK
Not ok
Regulate FREEDBACK
Process LOOP
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What is System Control
• Systematic And Effective Way Of
Keeping, Updating And Managing
Documents
• Establishing Systems:
Vertical / Horizontal Through
Teams / Procedures
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PURPOSE
To standardized the procedure for the development
and to implement Hospital-wide/ cross functional
and departmental Policies and Procedures (PP).
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What to Control
• (PP) Hospital Policy and Procedure
• (DI) Departmental Instructions
• (CG) Clinical Guidelines/
• (SNCP) Standard Nursing Care Plans
• (FS) Fact Sheets
• (JD) Job Description
• Forms
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System improvement
• The Aim Of System Improvement Is Not
Only To Resolve Immediate Problems
But Also To Aim For Continuous
Improvement Through Pro-active
Measures, Using Quality Improvement
Techniques And Tools
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System improvement
• 1- Management Team Meetings.
• 2-Communications.
• 3-Occurrences/ Patient complaints.
• 4-Mortality /Morbidity.
• 5-Utilization of beds.
• 6-Customer /Patient Satisfaction.
• 7-Clinical Performance Measurement (Medical audit)
• 8-Process improvement
• 9-Level of Service indicators (LSIs)
• 10-Internal Audit.
• 11-Annual Review of the TQM improvement System.
• 12-Tools
• 13-Quality Management 59
STAFF DEVELOPMENT
• 1- Orientation Of All Staff To TQM Concept.
• 2- Provide Training Regarding TQM Related
Topics On A Regular Basis.
• 3- Development Of Educational Programs.
• 4- Perform Rounds To All Departments On A
Regular Basis To Assist Staff And To Ensure
Implementation Of TQM And The EGY Standards.
• 5- Support Training Qi Tools In All Departments.
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Quality Management Principles
• Leadership commitment is the Key.
• Focus on systems not on individuals.
• All decisions are based on information derived from
reliable data.
• Quality is what is perceived by the customer as
quality.
• Quality management is preventive and proactive not
reactive or a quick fix.
• Quality empowers people; it does not police them.
• The modern approach to quality is thoroughly
grounded in scientific and statistical thinking.
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Quality Management Principles
• Sound customer-supplier relationships are absolutely
necessary for sound quality management.
• Productive work is accomplished through effective
structure and efficient processes.
• Defects in quality come from problems in processes.
Understanding the variability of processes is a key to
improving quality.
• Quality measurement should focus on the most vital
processes.
• Poor quality is costly.
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Quality in Healthcare Relates To People Management.
To Market Your Healthcare Organization by Quality,
You Have To Have and Admit:
Top Management/Leadership Commitment
Cultural Changes Campaigns
Strategic Planning and SWOT Analysis
Redesigning of the Organizational Structure
Prompt/ Comprehensive Data System
Formulated Healthcare Standards
Preparation/Application for Accreditation
Awareness/Training Campaigns
Assessment of Customer Satisfaction/needs
Prompt Resource Allocation
Prompt Decrease of Waste
Proper Marketing Planning 63
THANK U
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