ESSAY – QUALITY MANAGEMENT IN HEALTH SERVICES
Clinical governance coupled with quality HRM or Human Resources Management are two of the most important pillars of Patient care & Health Services. While there are instances where the health care services have detoriated over time, but in many cases they have also proved fruitful in serving their patients. However with the increased demand for quality health care the cost of the healthcare services is also increasing rapidly. In order to tackle the problem, governments across the world have come up with different innovative ideas of their own which is being manifested through the implementation of different guidelines & framework. Almost all the health care reforms across the world are trying to focus on strategic planning which in turn would facilitate Total Quality Management across the Health care services. However the concepts of quality namely TQM, Lean Management or application of Six Sigma in the Health Care services remain insignificant unless the concept of quality could be defined with respect to the Health Care Services (Hokkanen, Väänänen, & Seppänen, 2017). This essay will try to provide a detailed analysis of the quality management principles with respect to their relevance to the modern day Health Care services & thereby would try to determine the effectiveness that these principles could bring about in the present day incumbent practices. Although Quality Management Principles are well defined, the need is there to align them with their required usages in the Health care services. Along with that it is also important to set standard measures & therefore monitor them over the period of time to measure the increase in the effectiveness. This essay will also discuss the related feasibility & suitability of these principles & their respective applications if any in the Health Care Services domain (KathrinCresswell & Sheikh, 2013).
The concept of Quality management in the Health care services dates back to as early as 19th century AD. The first instances of the improvement in the quality of the services can be attributed to the works of Florence Nightingale as early as the 19th Century. At that time the concept of quality was not well defined & therefore the services received by the patients all across the world varied from region to region. Quality was determined & implemented not as per the convenience of the patients but as per the convenience of the implementors. Hence the varied quality called for the unification in the reforms, laws & guidelines. In 1913, the association called ACS or American College of Surgeons was formed. The aim of this institution was to define & analyse the different types of qualities prevalent across the regions. It was one of their earlier works that finally materialized in the form of “Hospital Standardization Process” (Buthmann, 2010). Though the development took place very slowly but it was being implemented & therefore came into force after 1930s. At that time & even till 1992, there have been numerous theories & propositions with respect to the Quality Standards in the Health Care Services. While many are of the opinion that Health Care Services should have integrated Quality Management Principles, there are more who say that the principles applied on the shop floor could not be integrated in a patient care facility. From the beginning of 1990s, there have been dedicated & focussed efforts towards improving the quality in the Health care services (Davidson, et al., 2014). The dedication & focused efforts could be attributed to the focus of the governments across the world to improve their Healthcare Index in comparison to the other countries of the World. This has resulted in the culmination of many institutions at country levels who have started working on Quality Management to improve the health care services of their country. Some of the most prominent examples in this context are ASQ or American Society for Quality Health Care, QCI or Quality Council of India, The Australian Commission on Safety and Quality in Health Care or ACSQHC etc. All these organizations have been institutionalized with an aim of improving upon the quality & safety standards in the current health care practices of the world (KathrinCresswell & Sheikh, 2013). Some of the major objectives of these organizations are to map the variability in the standards of Health care services of the different health care organizations of their respective regions & thereby determine the incumbent practices in comparison to the different set industry benchmarks of WHO or Commonwealth guided organizations. For example, ACSQHC have defined a set of standards called the NSHQS in order to understand the current industry practices towards Healthcare & thereby implement the same across the different health care centres of Australia. Although these standards & set benchmarks follow some common guidelines of their own, they also play an important role to understand the priorities as per the requirement of the region and thereby push forward the agenda of bringing improvement towards the same (Ory, Smith, Mier, & Wernicke, 2010).
As per the famous management philosopher, Crosby, Quality can be defined as the conformance to set specifications or requirements. In the context of the manufacturing where products are being made according to the set standards, the conformance to specifications or requirements are some of the mandates that define the final output. Although the concept of Lean Management & Six Sigma is highly correlated to the product industry, recent literature study by researchers across the world have shown a strong correlation of these concepts to the Service Industry also (Asq.org, 2015). With respect to the Health Care services Quality of the specifications or the performance could be related to the factors such as Healthcare Security, Attitude of the staff, Role of the different doctors, delay in terms of services or time required to complete a surgery or such other things. Some of the areas where the Quality management principles have really helped or is perceived to provide cost & time effectiveness are Quality of the care that is being present across the network of health care centres, quality of the management & the administration, quality of the doctors & the caring staff in the organization (Guth & Kleiner, 2015) . The TQM movement in the Health care has now become a movement rather than a phenomenon & thereby the health care service centres are trying to implement TQM across different processes with the sole objectives of improving efficiency, reducing costs & thereby providing quality health patient care. While majority of the service centres have tried to adopt the concept with open hands, many have provided resistance in embracing the same (Buthmann, 2010). But after carefully analysing the effectiveness & the benefits, most of the institutions have agreed to the principles & have decided to work on the same. TQM places maximum importance to increased customer satisfaction which indirectly leads to the increase in their market share & profitability. Some of the major hospital networks have even taken TQM as a part of their Operational strategies so that they could effectively improve their competitiveness with respect to their peers (Eboli & Mazzulla, 2014). While many researchers have debated whether the improvement in the Hospital care services could be attributed to TQM or not, following are some queues which show clear indications of the linkages of these services with respect to the organizations under considerations. The Health care organizations are dependent on their customers & therefore have started implementing the feedback from their customers on more frequently that they were doing previously. They are trying their best from all ends to meet the definite customer requirements. Thus they are trying to abide by the 1st principle of TQM called the “Customer Focussed Organization”. With respect to the 2nd Principle of TQM, the Leadership, the organizations are trying to put effective & efficient leaders in the top most positions of their organizations. These leaders in turn are trying to maintain a unity of information & therefore maintain quality focused environment within their organization. They are engaging all the stakeholders to improve upon the desired quality. This also conform to the 3rd principle of TQM (Al-Abri, 2007). As per the 4th Principle, the organizations should have a process focussed approach. The Health care service institutions are also focusing on improving their processes as evident from the several implementation activities with respect to BPR or BPM or Innovation. The management across all the organizations are trying to create a definite framework through which quality services are being applied to the different patient parties. Through the framework the institutions are trying to improve upon the incumbent processes on a continual basis. This relates to 5th & the 6th Principles of TQM (Ahmed, Manaf, & Islam, 2013). The implementation of Dashboards or ERP or different visual aids, could be attributed to the 7th Principle of TQM which states that the organizations should have facts while making decisions. The visual approach to decision making has helped the organizations to improve upon some of the loopholes & thereby act according to the industry benchmarks. The hospitals have also adopted the concept of mutually beneficial relationship strategy with their suppliers. This confirms to their 8th TQM principle (ASQ, 2016).
As evident that the Hospital care systems are working in conformance to the TQM and when Deming principles are taken into consideration, some of the observations with respect to the same are, that some of the prominent network hospitals in the world have adopted the principle of having zero defects in their own services as well as from the services or the products of their suppliers. The institutions have also gone to the extent of embracing the continual improvement system which Deming have repeatedly stressed upon from Quality Management (Eboli & Mazzulla, 2014). These organizations have also implemented several education programs & training plans in order to keep up with the changing trends. The higher management is also working towards removing the different barriers & hindrances which are clogging the growth of the organizations. Top Management & Government has also put forward the agenda of improving the practices. Thus it could be concluded that Hospital Network care services conform with the Deming Principles also (Busari, 2012).
Lean Six Sigma is another concept of Quality Management which focuses on eliminating the varied defects. In case of Healthcare services, a defect can result in death instead of life. Hence it is very important for the health care services to emphasize upon the importance of the quality services. Lean Six Sigma concepts utilized the concept of DMAIC a 5 step approach from controlling & improving current processes. It is not only relevant to the current day practices prevalent across the different organizations but is also relevant to improve upon their already effective processes. Many organizations across the world have already started adopting this concept & have brought significant improvement in their processes. In another research paper, the researchers have shown that the LSS or the Lean Six Sigma approach is one of the best ways by which critical patients could be dealt with effectively (Grigg & Manderson, 2016). The methodology involved in the LSS process actually takes into consideration the standardized norms & thereby evaluates the ways & areas where the optimization principles could be applied. It focuses on reduction of any desired process within the whole system. Thus several aspects of the Healthcare could be addressed through this method. It can help in reducing the wait time of the patients, or reduce the lost charges, help in minimizing the medical records handling errors or even help in reducing the turnaround time of the diagnostic results or length of the stay of the patients in any medical facility. One such example is the case of North Mississippi Medical Center, which have long before realized the importance of Lean Six Sigma & therefore implemented the same few years back (Grigg & Manderson, 2016). The result was phenomenal. By implementing Lean Six Sigma into their processes of discharging patients, the Medical Center was being able to reduce the errors in the varied discharge documents by more than 50%. One of the most important characteristics of the Lean Six Sigma Quality Control concept is that the concept not only helps in removing the defects from different processes but also help in freeing up the additional capacity which was plagued due to the unsorted framework (Ahmed, Manaf, & Islam, 2013). With the availability of the new capacity, the increased demand could be met & hence the revenue & profitability of the centres go up significantly (ASQ, 2016).
As evident from the different research that Quality definitely plays an important role when it comes to the Healthcare services. However some of the important concepts which must be taken into consideration for the Health care services are the Quality Assurance & Quality Control (Berto, D’Ilario, Ruffo, Virgilio, & Rizzo, 2010) (Rasamanie & Kanapathy, 2011). As already stated before, PDCA cycle acts as a definite tool through which comprehensive actions could be planned with respect to quality improvement in the industry. This was proposed by Deming in the year 1950 for mainly the manufacturing & shop floor processes. But still today it is significantly used across all the organizations of the world to improve upon the existing processes. Although his concepts were also borrowed from previous research, but the concepts were unique & thus found relevant adoption across industries. Although the concepts are being used in the organizations, some of the challenges still exist when it comes to Quality Management & Quality Assurance. One of the main challenges in this respect is the measurement of the quality parameters. As the range of outcome varies from patient to patient basis, it is very difficult for the organizations to maintain a common standard of measurement (Thimbleby, 2013). However, in absence of any specific framework, umbrella frameworks could be selected. Some of the frameworks which have helped the organizations in this industry achieve success are measurement at structural, process & outcome levels. For the first level or the structural level, the quality parameters relates to the varied parameters at the organization level. The available measurements could be based on the varied physical & structural parameters. Physical parameters include the different available resources such as the equipment, buildings etc. & the structural or the staff level parameters include the attitude & the skills of the team members in that organization. The second level indicators are the ones which are being associated with the care processes. These are effectively used to measure & evaluate the interaction between the providers of the health care services & the health care end users (Sailaja, Basak, & Viswanadhan, 2015). Two of the most important aspects in this respect are the interaction between the parties involved along with the actual provided care. One of the measurement in this respect could be the measurement of a therapy as received by the patients. Thus these types of indicators are rather an extension of the structural parameters only which helps in determining the quality of the therapy received or the duration of the therapy or the apt implementation of the therapeutic procedures. The third level of quality parameters are the parameters related to the actual outcomes. These consist of the satisfaction index of the clients as well as the health status of the patients under consideration (Wernicke, 2012). These are one of the complex ways of measurement of the quality parameters. Here no set benchmarks could be set as each & every index varies from patient to patient. For example the socio-demographic characteristics of the patients could be different or rather the intensity level of the different diseases could be varied. Secondly the variation in the outcome is also not in the hand of the service providers; rather it depends on the capability of the patients themselves. Hence in these types of cases the quality measurement parameters could be changed as per the case-mix basis & should also vary from patient to patient (Willis, 2013).
Thus it could be concluded that Quality Management principles are applicable across industries whether it is a manufacturing industry or a healthcare industry. Though debates may happen about the relevance, but the discussion has made it evident that Quality improvement or Quality assurance principles could be readily applied across different levels of the varied organizations working in this industry. The TQM principle which focuses on the importance of process, management or stakeholders is very much relevant to any health care centre also. When it comes to the concepts of Six-Sigma for reducing defects, there are classic examples where the organizations have used the Six-Sigma Principles to reduce the number of defects in their different processes in order to increase their availability of the resources. This has ultimately resulted in the increase of the revenue & the increase in profits for these institutions. PDCA cycle which has been used for decades in the manufacturing organizations also finds its effectiveness hen used against the structural level processes of the firms or the health care service centres operating in this industry. Although researchers argue on the apt utilization of the principles, but evidence show that the quality principles are being increasingly used definitely at the structural & the mid-level processes. But when it comes to the clinical level processes the hindrances are still there. In case of a manufacturing organization each & every outcome could be measured, analysed & monitored with respect to some set benchmarks. But when it comes to measuring the quality of direct interaction or health care services the final satisfaction of the patients or the health recovery index of the patients is needed to refer. Here lies the actual problem. Patients may vary as per their demographic or sociological differences & also the diagnosis could also be different with different intensity levels of the issues. Hence at this juncture it is important to take into consideration the variability in the process outcomes altogether. Thus quality principles are yet to be adopted fully by the different Health care institutions at the clinical or the outcome levels. But research is going on to find ways by which even the customization processes could be standardized under definite frameworks & it is only a matter of time when all the processes could be measured, analysed & evaluated by definite quality principles & measurement.
References
Ahmed, S., Manaf, N., & Islam, R. (2013). Effects of Lean Six Sigma application in healthcare services: a literature review. PubMed, 189-194.
Al-Abri, R. (2007). Managing Change in Healthcare. Oman Medical Journal, 22(3), 9-17.
ASQ. (2016, January 23). Lean Six Sigma in Healthcare. Retrieved from http://asq.org: http://asq.org/healthcaresixsigma/lean-six-sigma.html
Asq.org. (2015). COST OF QUALITY (COQ). Retrieved February 7, 2017, from http://asq.org/learn-about-quality/cost-of-quality/overview/overview.html
Berto, P., D’Ilario, D., Ruffo, P., Virgilio, R. D., & Rizzo, F. (2010). Depression: cost-of-illness studies in the international literature, a review. J Ment Health Policy Econ, 1(3), 3-10. doi:https://www.ncbi.nlm.nih.gov/pubmed/11967432
Busari, J. O. (2012). Comparative analysis of quality assurance in health care delivery and higher medical education. PMC, 121-127.
Buthmann, A. (2010). Cost of Quality: Not Only Failure Costs. Retrieved February 7, 2017, from https://www.isixsigma.com/implementation/financial-analysis/cost-quality-not-only-failure-costs/
Davidson, N., Skull, S., Burgner, D., Kelly, P., Raman, S., Silove, D., . . . Smith, M. (2014). An issue of access: Delivering equitable health care for newly arrived refugee children in Australia. JPCH, 569-575.
Eboli, L., & Mazzulla, G. (2014). A New Customer Satisfaction Index for Evaluating Transit Service Quality. Venice: University of Calabria.
Grigg, K., & Manderson, L. (2016). The Australian Racism, Acceptance, and Cultural-Ethnocentrism Scale (RACES): item response theory findings. International Journal for Equity in Health, 5(4), 15-49. doi:https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-016-0338-4
Guth, K., & Kleiner, B. (2015). Quality assurance in the health care industry. PubMed, 33-40.
Hokkanen, L., Väänänen, K., & Seppänen, M. (2017). From Minimum Viable to Maximum Lovable: Developing a User Experience Strategy Model for Software Startups. Journal of Quality and User Experience., 1-13.
KathrinCresswell, & Sheikh, A. (2013). Organizational issues in the implementation and adoption of health information technology innovations: An interpretative review. International Journal of Medical Informatics, 82(5), 73-86.
Ory, M. G., Smith, M. L., Mier, N., & Wernicke, M. M. (2010). The Science of Sustaining Health Behavior Change: The Health Maintenance Consortium. PMC, 34(6), 647-659. doi:https://www.ncbi.nlm.nih.gov/pubmed/20604691
Rasamanie, M., & Kanapathy, K. (2011). The Implementation of Cost of Quality (COQ) Reporting System in Malaysian Manufacturing Companies : Difficulties Encountered and Benefits Acquired. International Journal of Business and Social Science, 2(6), 243-247.
Sailaja, A., Basak, P. C., & Viswanadhan, K. G. (2015). HIDDEN COSTS OF QUALITY: MEASUREMENT & ANALYSIS. International Journal of Managing Value and Supply Chains (IJMVSC) , 6(2), 13-25.
Thimbleby, H. (2013). Technology and the Future of Healthcare. PMC, 28-39.
Wernicke. (2012). The science of sustaining health behavior change: the health maintenance consortium. NCBI, 34(6), 647-659. doi:https://www.ncbi.nlm.nih.gov/pubmed/20604691
Willis, C. D. (2013). Sustaining organizational culture change in health systems. Journal of Health Organization and Management, 30(1), 2-30. doi:http://www.emeraldinsight.com/doi/abs/10.1108/JHOM-07-2014-0117