1. AN OVERVIEW OF QUALITY AND TQM

2. What is Quality

3. Managing for Quality How to manage for Quality To attain quality, the organization should establish its vision and goals. The conversion of goals into results (making quality happen) is done through managerial processes. Managing for quality makes extensive use of three managerial processes know as the "Juran trilogy“ Quality planning Quality control Quality improvement

4. Juran’s Trilogy Diagram

5. Healthcare Quality !!! Generally, quality means meeting and exceeding customer expectations. In healthcare, it is complicated. Obviously, patients are the customers. However, they do not understand what they receive. If insurance is involved then there is another customers. Therefore, healthcare quality is evaluated from different perspective. Definitions: 1- The Institute of Medicine defined Healthcare Quality as The degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

6. 2- The Community of Health Accreditation Program defined quality as The degree to which consumers progress toward a desired outcome. 3- The National Association of Quality Assurance Professionals described quality as The level of excellence produced and documented in the process of patient care, based on the best knowledge available and achievable at a particular facility. Healthcare Quality !!!

7. A general note: The problem is that the healthcare system is complicated due to its high number of job titles. This specialization that originally designed to improve quality is now creating breakdown in quality processes. Healthcare Quality !!!

8. Quality Dimensions in Healthcare If you are buying a car there are dimensions of quality that we can evaluate the car's quality against such as Safety, fuel efficiency and comfort of driving and so on. Can we use the same dimensions for the healthcare system? The literature lists 6 quality dimensions for the healthcare system. 1- Safety: Are we harming people with our care? Are we adding to the burden of sickness? For example, pregnant patients should adequately be protected from radiation exposure. A safe healthcare system reduces its risks from the care itself.

9. 2- Effectiveness: It is basically Matching science to care. If science says this drug can help this disease then we have to use this drug. If science says this drug cannot help then we do not use it. o Avoiding over use of things that do not help and assuring using things that help. o Statistics show that healthcare systems have problems with effectiveness. Quality Dimensions in Healthcare

10. 3- Patients centeredness: Patients must be in the center of the healthcare system. Patients should be in control of their own care. They should take decisions about what affecting them. (ethics should be respected) (Nothing about me without me) Quality Dimensions in Healthcare

11. 4- Timeliness: Avoiding delays. Patients are familiar with the waiting rooms even in emergency. Patients also suffer from appointment delays. The healthcare system must reduce the needless delays. Some delays are needed !! Quality Dimensions in Healthcare

12. 5- Efficiency: Avoiding waste. In most healthcare systems, they give things that do not help and the duplicate procedures and tasks and they lose records (usually misplaced) Quality Dimensions in Healthcare

13. 6- Equity: Closing the gap in justice in healthcare. Are people in rural areas have the same care as people in large cities? Do insured and uninsured patients receive the same care? Healthcare providers should pay attention to these quality dimensions and these dimensions must be reflected in their mission statements. Quality Dimensions in Healthcare

14. Total Quality Management (TQM) TQM is an effective system for integrating the quality development, quality maintenance and quality improvement efforts of the various groups in an organization so as to enable production and service at the most economical levels which allow for full customer satisfaction. It is best thought of as a philosophy that stresses the “total” of TQM and puts quality at the heart of everything that is done by the organization.

15. Total in TQM means the following Meeting the needs and expectations of customers; Covering all parts of the organization; Including every person in the organization; Examining all costs which are related to quality, and getting things “right first time” ; Developing the systems and procedures which support quality and improvement; Developing a continuous process of improvement. Total Quality Management (TQM)

16. Quality in TQM means the following The prime task of any business is to understand the needs of the customer, then deliver the product or service at the agreed time, place and price, on every occasion. This will retain current customers, assist in acquiring new ones and lead to a subsequent increase in market share. Total Quality Management (TQM)

17. Management in TQM means the following Top management lead the drive to achieve quality for customers, by communicating the business vision and values to all employees; ensuring the right business processes are in place; introducing and maintaining a continuous improvement culture. Total Quality Management (TQM)

18. Deliberate Defectives – A short story The story illustrates the difference in attitude between TQM and non- TQM companies. IBM, the computer company, in Ontario, Canada, ordered a batch of components from a Japanese manufacturer and specified that the batch should have an acceptable quality level (AQL) of three defective parts per thousand. When the parts arrived in Ontario they were accompanied by a letter which expressed the supplier’s bewilderment at being asked to supply defective parts as well as good ones. The letter also explained that they had found it difficult to make parts which were defective, but had indeed managed it. These three defective parts per thousand had been included and were wrapped separately for the convenience of the customer.

19. Assignment #1 1- What is the mission statement of your healthcare centre/ hospital? Does the mission statement reflects the healthcare quality dimensions? 2- Explore the quality system in your healthcare centre/ hospital? (procedures, reviews, accreditation, etc) 3- What does the quality system measures? and why? -The identified quality systems in the healthcare centers will be presented in class. A maximum of 8 ppt slides (including the cover slide) should be emailed to me before 11:30 am of the lecture’s day. - Each and every member of the group must participate in the presentation. The presentation should not exceeds 20 minutes including questions.