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PubMed1999

Quantitative research versus quality assurance, quality improvement, total quality management, and continuous quality improvement.

The purpose of this report is to provide a review of the scientific method used in the quantitative research studies for consumers, evaluators, and applied nurse researchers. The fundamental characteristics of the problem-solving/ performance-improvement processes of quality assurance, quality improvement, total quality management, and continuous quality improvement are described. Research is compared with these processes, and is followed by a discussion about the publication of quantitative research findings.

Humans↗
PubMed1994

A first step in total quality management of nursing facility care: development of an empirical causal model of structure, process and outcome dimensions.

While the structure, process, and outcome taxonomy has long been used in the field of health care quality measurement and evaluation, it has not been used in a true causal model which assesses facility level quality. Total quality management and continuous quality improvement call for routinely assessing facility and resident level quality in a causal framework. This paper presents a causal modeling methodology as a more appropriate method for assessing and understanding the inter-relatedness among each of the quality dimensions of Nursing Facility care, and presents how such a causal model directly relates to the notion of continuous quality improvement. The methodology consists of five steps: (1) sample definition and data collection, (2) data reduction through factor analysis, (3) development and testing of a causal model through path analysis, (4) identification of patterns of care through cluster analysis, and (5) integration of the model to both continuous quality improvement and to complex relationships involving quality and organizational variables. The methodology is fully illustrated by using a sample of 104 nursing facilities in Wisconsin in which quality dimensions have been captured through the Quality Assessment Index. The analysis demonstrates that nursing facilities may be substantially benefited by having access to causal linkages which materially affect outcome quality. Management would then have first-hand knowledge of the structural characteristics and the process activities that they may pursue in order to improve outcome quality.

Cluster Analysis↗
PubMed1997

Implementation of total quality management after reconfiguration of services on a general hospital unit.

In 1992 the New York State Office of Mental Health issued a statewide plan for mental health services to reduce the number of inpatient beds in state-run facilities from approximately 11,000 to between 6,000 and 8,000 by the year 2000. This reduction resulted in at least a 25 percent increase in psychiatric beds at local general hospitals. In 1992 Albany Medical Center Hospital's department of inpatient psychiatry established an interdisciplinary committee to address changes resulting from the reconfiguration of services to chronic mentally ill persons. The committee established procedures to use the principles of total quality management to respond to problems and to continuously improve the therapeutic milieu. The authors describe how these principles were used to create a patient satisfaction survey, to examine and improve part of the hospital admissions procedure, and to review and revise treatment planning documentation. A concurrent review committee reviews patients' records to ensure accuracy of documentation and quality of care.

Chronic Disease↗
PubMed1994

Total quality management in the hospital setting.

With the increasing demands on hospitals for improved quality and lower costs, hospitals have been forced to reevaluate their manner of operation and quality assurance (QA) programs. Hospitals have been faced with customer dissatisfaction with services, escalating costs, intense competition, and reduced reimbursement for services. As a result, many hospitals have incorporated total quality management (TQM), also known as continuous quality improvement (CQI) and quality improvement (QI), to improve quality care and decrease costs. This article examines the concept of TQM, its rationale, and how it can be implemented in a hospital. A comparison of TQM and QA is made. Examples of hospital implementation of TQM and problems and issues associated with TQM in the hospital setting are explored.

Hospital Administration↗
PubMed2005

Medical errors--is total quality management for the battlefield desirable?

There has recently been a great deal of discussion in both the lay press as well as the medical press regarding the incidence of errors that occur during medical practice. There have been many discussions of how quality control measures from industry can be applied to the health care system. Indeed both civilian and "brick and mortar" military medical treatment facilities are adapting these techniques. It is important that we understand the principles behind Total Quality Management (TQM) as well as its techniques and limitations. TQM is based on limiting deviation from an accepted standard of practice. These principles may be as applicable to our military health care facilities in a field environment as they are to our fixed facilities, although the standards used for measurement may have to be modified to adapt to different constraints of environment and resources. TQM techniques can nonetheless be applied in virtually any facility to ensure the best possible care and outcomes for our soldiers.

Humans↗
PubMed1992

The big picture. Total quality management and continuous quality improvement.

The pressure to improve the quality of clinical and customer service outcomes continues to escalate. In most cases, sustained improvement (either incremental or breakthrough) is a direct result of improving service delivery and work processes. The challenge, for managers, is to design work processes that predictably lead to satisfying and cost-effective results. Total quality management (TQM) and continuous quality improvement (CQI) may seem like "this year's fads," but they are form, not fashion. TQM and CQI processes generate a customer-responsive environment in which employees can contribute to achieving the organization's mission, vision, and strategic objectives.

Humans↗
PubMedDate not supplied

The benefits of total quality management.

In this article, we will review the implementation of the ISO 9000 quality system in the Department of Nuclear Medicine. We will also discuss the benefits of working with the ISO 9000 standards and explain why we have shifted our focus from ISO 9000 towards the EFQM model. After an introduction concerning Total Quality Management and the EFQM model, we will describe how we have used the EFQM model to date and how we intend to implement TQM in the future.

Humans↗
PubMed1994

Developments in total quality management in the United States: the Intermountain Health Care perspective.

In summary our purpose has been to evaluate quality in the following terms. Best process of care--narrowing the variation of care decisions, working towards the best method. Best clinical outcome--decreased morbidity ond mortality. Best patient satisfaction--both for clinical outcome and the process of care. Best value--best value at the lowest cost. At Intermountain Health Care we believe that the best way to achieve the best quality improvement in a health care system is to involve all of the participants--patients, providers, and systems--in employing the principles of total quality management. Patient involvement--in prevention; participating in best care process through education and utilisation; in evaluating functional status before, during, and after intervention; in satisfaction; in clinical outcome and follow up with providers. Provider involvement--in planning, implementing, analysing, and educating; in defining guidelines; in reassessing and defining guidelines; in reassessing and continually modifying the care map, always striving for "best care." System involvement--in providing structure and mechanisms, support staff, and information systems and being willing to focus on quality as a part of its mission. An American philosopher, George Santayana, once said: "What we call the contagious force of an idea is really the force of the people who have embraced it." It will be up to all of us collectively to become the force behind moving quality management principles into the forefront of patient care methodology and ensuring that quality remains as the guiding principle of health care delivery in the future.

Adult↗
PubMedDate not supplied

Implementing total quality management and reshaping delivery systems in a community hospital.

In today's healthcare marketplace, leadership requires more than the delivery of technologically sophisticated patient care. Leadership can be accomplished only by an organization energized with a mission that focuses on providing high-quality, technologically sophisticated, and cost-effective primary healthcare. The paradigm shift to total quality management at the authors' not-for-profit community hospital involved not only the adoption of the philosophy, tools, and techniques espoused by quality experts, but also a restructuring of the organization from a hierarchical format to one focused on the patient.

Community-Institutional Relations↗
PubMed1994

Implementing total quality management in the health care industry.

Health care organizations across the nation have begun instituting quality improvement programs in order to meet the demands of improving service and clinical quality in health care. The implementation process requires time, effort, and money in order for the health care organizations to learn who their customers are and what they want. The results, which sometimes are not recognized until after a two- to three-year period, include reduced costs by cutting waste and complexity and by doing things right the first time. Still, there are many challenges in adapting total quality management (TQM) to public organizations such as the health care industry. This article discusses the founding principles of TQM and how they are applied in implementing TQM to enhance quality in health care organizations. This article also forecasts the future of TQM implementation in public health care.

Hospital Administration↗
PubMed2000

Between evidence-based practice and total quality management: the implementation of cost-effective care.

There is an increasing number of studies showing that patients often do not receive necessary care or receive care that is not needed, inefficient or even damaging. There is no lack of ideas and approaches on how to improve practice. In the last decades we have seen the rise of fascinating models for quality improvement, for instance Evidence Based Medicine, Total Quality Management and Patient Partnership. These models are interesting and potentially very valuable in improving patient care. However, the evidence for their (cost-) effectiveness is very limited. The challenge for the years to come is to design strategies for quality improvement that integrate elements from the different models and to set the step from anecdotal evidence for these strategies to systematic evaluation in order to distinguish between faith and fact in the field of improving care.

Cost-Benefit Analysis↗
PubMed2001

[The total-quality-management-analysis of the continuation and discontinuation of alcohol family treatment: a grassroots approach].

A family support/treatment program was provided to thirty-three cases where a drinking family member (identified patient) had shown alcohol related problems but not yet admitted the problem. After a period of between thirteen and twenty-one months of family treatment, fourteen (42.4%) identified patients started their own treatment. The only statistically significant factor that was related to the patients' treatment program participation was the continuation of family members' involvement in a family treatment program. Among the thirty-three cases, a little less than one half (48.5%) continued the family program. In order to increase the patients' participation, it is crucial to encourage family members to continue their family support/treatment program. In order to identify factors that contribute treatment continuation as well as dropouts, workshops were held with those who dropped out and those who continued the family treatment program. The Total-Quality-Management (TQM) affinity and arrow diagram techniques were employed to classify the participants' statements and to find cause-effect relationships among the identified factors, respectively. Five family treatment discontinuation factors were identified: 1) a lack of information about family support program, 2) resistance against a "family change" orientation in family treatment program, 3) family member burnout, 4) a misfit between family needs for immediate problem solutions and what family program offers, and 5) a temporal improvement of patients' drinking problems. While widely varied factors were found to contribute discontinuation, only a very few factors were identified to facilitate the treatment continuation. It was concluded that treatment discontinuation, rather than continuation, was the norm among the families of problem drinkers. Based on the above findings, three kaizen plans were proposed. First, in order to make sure that family members obtain necessary information about the family support/treatment program, a pamphlet would be created and handed out to those who come to family treatment. Second, family support efforts would be emphasized more. Treatment staff is expected to become more cautious with regard to the family behavior change facilitation, especially at the early stage. Third, treatment staff is expected to become more aggressive about contacting family group members when they do not show up to a meeting.

Adult↗
PubMed2001

[Measurement of the outcome quality as beginning of total quality management in otorhinolaryngology].

BACKGROUND: The last years are characterized by a change of paradigms in the evaluation of medical therapeutical strategies. The term quality of life (QoL) has been established in oncology and could be demonstrated as a subject of highly qualified investigations which were published during the last years. An extendend quality management is correlated with the possibility of cost-effectiveness measurement and arrangement in a time characterized by decreasing financial resources of the hospitals and university departments. The experiences in the field of quality analysis could offer precious tools to optimize structures, processes and results of treatments. This aim is strongly supported by the expected law "Gesundheitsreform 2000". METHOD AND RESULTS: Therefore reliable, valid tools are needed to calculate the effects of therapies. The combination of global and specific questionnaires include the possibility to compare oncologic data of different entities of malignomas. A couple of questionnaires in otorhinolaryngology were developed in the last decade involving the fields of malignomas of the upper aerodigestive tract, rhinosinusitis etc. CONCLUSIONS: Ishikawa, the founder of "Total Quality Management" and of the "Quality Circ", pointed out the high importance of customer satisfaction. Whereas the patient is in the mid point of medical treatment there are hardly any investigations about customer satisfaction published. Therefore it is necessary to develop and establish validated tools for the measurement of quality dimensions. The short, middle and long-lasting effects of a treatment could be calculated by quality of life measurements. The QoL is here of very strong importance, especially since economic aspects are included.

Germany↗
PubMed1999

[Clinical guidelines as part of total quality management. Analysis of heterogenous treatment concepts of sepsis in various clinics with computer assisted generation, logical testing and complexity assessment of clinical algorithms].

Generation, local tailoring, implementation and evaluation of clinical guidelines is an integral part of quality management. Clinical guidelines are intimately related to the independency of physicians' decisions. By this the physicians should be responsible for guideline development and guarantee the use of adequate methods of total quality management and outcome assessment. Formal consensus finding and transparency of evidence are necessary to guarantee the use of guidelines. Clinical algorithms are highly formalized and they are well suited for generation and analysis by the software ALGO. Determination of complexity and comparison of the clinical contents of algorithms is done by the scores CASA (Clinical Algorithm Structural Analysis) and CAPA (Clinical Algorithm Patient Abstraction). In a study of 22 clinical departments on treatment management concepts in sepsis following anastomotic insufFiciency in colorectal carcinoma a considerable heterogeneity was shown using this program.

Algorithms↗
PubMed1993

Can networked hospital performance comparisons be linked with total quality management? A scenario based on the Pennsylvania Health Care Cost Containment Council.

The Pennsylvania Health Care Cost Containment Council publishes annually performance comparisons on hospitals in nine regions of the state. As a result, hospitals are under public pressure to use these data in Total Quality Management programs. This article illustrates both the opportunity and the risk that publicly funded information poses for hospitals.

Cost Control↗