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From quality assurance to total quality management: how can quality assurance result in continuous improvement in health professions education?

CONTEXT: Quality assurance is a hot topic in many institutes for higher education. Quality assurance is a cyclic process, consisting of three steps: measuring, judging and improving. Many institutes in higher education collect data about the quality of their educational programme on a regular basis and with proper frequency, but these evaluative data are not always used to improve the quality of the programme. PURPOSE: The aim of this article is to demonstrate which conditions need to be fulfilled to ensure that quality assurance is a cyclic process resulting in continuous improvement. CONCLUSIONS: Quality assurance can only be successful, i.e. result in continuous improvement, if three conditions are met: the evaluation activities are carried out in (1). a systematic and (2). structural fashion and (3). are integrated in the organization's regular work patterns. Parts of the system for quality assurance at the Maastricht Medical School are presented to demonstrate how the three conditions can be realized in practice.

Education, Medical↗

Total quality management in laparoscopic cholecystectomy. Quality of care and quality perception in ambulatory laparoscopic cholecystectomy.

OBJECTIVE: Analysis of acceptance and perception of quality in patients undergoing ambulatory laparoscopic cholecystectomy. PATIENTS: 84 consecutive patients undergoing elective laparoscopic cholecystectomy within SVS (Servei Valencia de Salut) through a special plan for waiting lists. METHODS: A prospective analysis of related variables with quality perception evaluated by a specialized nurse with no interaction with the surgical team. RESULTS: Ambulatory acceptance, 80 percent; return to work or daily activities at 72 hours after surgery, 40 percent. Extra need of medical attention was as follows: emergency general practitioner 2.7 percent, emergency room attention in 1.3 percent, extra telephone interview with the surgeon 6.0 percent. Global estimation of the procedure was very good or good by 94.7 percent. CONCLUSIONS: High acceptance rate, high quality perception. Up to 20 percent of patients would change from ambulatory to traditional surgery, possibly due to cultural factors.

Ambulatory Surgical Procedures↗

Serum tumour markers: from quality control to total quality management.

Since the first clinical use of tumour markers, quality assurance has been considered only in a restrictive manner, that is, as a surveillance of the analytical process. In other words, quality assessment was roughly viewed as a synonymous with quality control. This is not surprising, since tumour markers are almost exclusively assayed by radioimmunoassays, whose analytical performance were suboptimal in the 1970s. Furthermore, tumour marker concentrations in biological fluids were very low (in the ng range); in addition, primary standards were not available and dose-response curves were set up with conventional calibrators. Therefore, quality control programmes have become mandatory to restrict intra- and inter-laboratory variability.

Journal Article↗

Implementing total quality management in the medical practice: managing the transition.

TQM has a place in the medical practice. While it will require that the practice deal with the many barriers to change in the practice, the results can be significant. Increased patient satisfaction, lower costs, improved quality of work life, and increased productivity can enhance the working of a practice at a time when there are significant pressures on the practice and physicians. TQM may indeed be a way for a practice to take more control of this changing environment rather than being controlled by it.

Organizational Innovation↗

Total quality management at Bethesda, Inc.

This article describes 4 years of TQM implementation at Bethesda, Inc., a private not-for-profit diversified healthcare organization. Bethesda has used a comprehensive implementation strategy involving the use of process improvement teams, hoshin planning, daily management of critical processes, and quality function deployment. The article includes four process improvement case studies demonstrating the use of the seven quality control tools and a nine-step process improvement model. Factors contributing to processes as well as obstacles are described.

Ambulatory Surgical Procedures↗