What is TQM

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What is TQM

  1. 1. Sandro C. Esteves, MD., PhD. Director, ANDROFERT Andrology & Human Reproduction Clinic Campinas, BRAZIL What is Total Quality Management (TQM)? Life Summit 2014 - ART TQM Forum, CHINA ISO 9001:2008
  2. 2. Outline o TQM definition o Applying TQM in Healthcare and IVF •  Performance Management •  Quality Management •  Risk Management o How to evaluate success of an IVF center according to TQM ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 2 2014 MARCH ANDROFERT
  3. 3. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION SC ESTEVES, 3 2014 FEBRUARY ANDROFERT
  4. 4. Definitions TOTAL Complete; absolute; comprehensive MANAGEMENT Administration; the process of dealing with or controlling things or people QUALITY Characteristic; nature; essential character; something that distinguishes ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 4 2014 MARCH ANDROFERT
  5. 5. o It varies from person to person, and it’s influenced by feelings; o Existing only in the mind; imaginary Quality is subjective… ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 5 2014 MARCH ANDROFERT
  6. 6. The only objective and measurable aspect of quality is the PROCESS
 Process = Any activity or set of activities that uses resources to transform raw material, supplies and labor (inputs) into products or services (outputs) ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 6 2014 MARCH ANDROFERT
  7. 7. Process within the organization that will ensure that the service provided is performed in a standardized way, and that results are analyzed and improvements are done constantly, to guarantee a service of excellence with consistent and stable results ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 7 2014 MARCH ANDROFERT
  8. 8. Process service standardized results analyzed improvements constantly done ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 8 2014 MARCH ANDROFERT
  9. 9. IVF is process-based, so TQM can be applied to IVF ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 9 2014 MARCH ANDROFERT
  10. 10. Why a Process is so Important for Quality Every work is a set of interrelated processes; Every process is subject to variation; The key to the ongoing improvement is systematically tackling and reducing processes’ variations ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 10 2014 MARCH ANDROFERT
  11. 11. Key points (1) The only objective and measurable aspect of quality is the PROCESS = set of activities that uses resources to transform inputs into outputs TQM is a process ensuring that service is performed in a standardized way, and that results are analyzed and improvements are done constantly, thus guaranteeing a service of excellence with consistent and stable results ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 11 2014 MARCH ANDROFERT
  12. 12. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 12 2014 MARCH ANDROFERT Applying TQM in Healthcare
  13. 13. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 13 2014 MARCH ANDROFERT Resources, training and opportunities for staff to develop and improve OHSS, multiparity, biosafety, health issues QM system Applying TQM in IVF
  14. 14. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 14 2014 MARCH ANDROFERT QMS: ISO 9001:2008 Determine needs and expectations of customers and others (legislation, professional societies, etc.) Mission Establish a quality policy, quality objectives, and quality indicators for the organization, QM focus Determine processes/procedures to achieve the quality objectives; Identify and provide necessary resources Process Determine means to prevent nonconformities (NC) (variation) and eliminate their causes; Register quality actions; Verify compliance NC; Registering; Auditing Establish and apply methods to measure effectiveness/efficiency of each process Monitoring Establish and implement a process that involves all personnel for continuous improvement Continuous improvement
  15. 15. Mission Statement Define who your patients are WHO Define what you do, and the services you provide WHAT Define how you do it: methods used, philosophy, objectives, etc. HOW ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 15 2014 MARCH ANDROFERT Our mission is to help couples with conception difficulties become parents, especially when the difficulty is partially or totally related to men, through counseling, diagnosis and treatment, offering personalized professional service of excellence, and using all available technologic resources
  16. 16. Quality Management Focus Brief, simple and direct statements that define the focus of your quality management system Quality Policy Objectives of each statement of your quality policy (they have to be measurable) Quality Objectives How you monitor your quality objectives (tools to check if your objectives, and therefore your policy is being achieved) Quality Indicators ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 16 2014 MARCH ANDROFERT
  17. 17. QMFocus ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 17 2014 MARCH ANDROFERT
  18. 18. Processes and Procedures Any activity or set of activities that uses resources to transform raw material, supplies and labor (inputs) into products or services (outputs) Process Sequence of steps to execute a task Important for standardization and replication Procedure ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 18 2014 MARCH ANDROFERT
  19. 19. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 19 2014 MARCH ANDROFERT
  20. 20. ! ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 20 2014 MARCH ANDROFERT Non-conformities Every deviation from what is established. Important to identify inconsistencies, weaknesses, and improvement opportunities
  21. 21. Registering Quality Actions & Auditing Actions taken to improve the service provided Improvement Actions Actions taken to avoid a potential non- conformity detected before it actually happen Preventive Actions Actions taken after a non-conformity has been detected to correct it Corrective Actions ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 21 2014 MARCH ANDROFERT
  22. 22. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 22 2014 MARCH ANDROFERT Registeringquality actions
  23. 23. Auditing Verify conformity Main Objective Processes, Procedures, Documents and Records Types ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 23 2014 MARCH ANDROFERT
  24. 24. Continues… Secretary! answers!the! phone! Is!it!a!new! patient?! Wants!general! information?! Secretary!gives! homepage!and! email!address! Wants!to! schedule!semen! test?! Secretary! verifies!type!of! test! Secretary! schedules! Wants!to! schedule! appointment?! Secretary! verifies!medical! preference! Yes! Yes! Yes! No! No! Yes! No! ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 24 2014 MARCH ANDROFERT Auditing
  25. 25. Monitoring Quality Indicators ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 25 2014 MARCH ANDROFERT
  26. 26. Continuous Improvement Fabiola Bento, MBE Quality Manager, ANDROFERT Establish unity of purpose and direction of the internal environment Create an environment where people are fully involved in achieving the organization’s objectives ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 26 2014 MARCH ANDROFERT
  27. 27. ContinuousImprovement
  28. 28. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 28 2014 MARCH ANDROFERT
  29. 29. •  Know your patients •  Define the processes to meet their expectations •  Define your goals and objectives, so that your procedures and processes help you achieve them •  Measure your performance and your patients’ satisfaction periodically to detect changes and new demands ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 29 2014 MARCH ANDROFERT
  30. 30. •  Involve all personnel in continuous improvement •  Make changes, adjustments, and improvements based on facts and not on assumptions •  And, last but not least, satisfy your patients! ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 30 2014 MARCH ANDROFERT
  31. 31. What a TQM guarantees is… Key points (2) ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 31 2014 MARCH ANDROFERT o A very well-organized workflow o Excellence in service provided o Focus on patient needs and satisfaction o Continuous improvement o  Increased operational efficiency and profitability
  32. 32. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 32 2014 MARCH ANDROFERT How to evaluate success of an IVF center according to TQM 
 Is your Center Successful?
  33. 33. ü Development of 298 quality indicators ü Twenty-four indicators selected based on consensus of importance; Six quality dimensions ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 33 2014 MARCH ANDROFERT
  34. 34. Consensus Quality Indicators Safety •  Complications, Errors/Mistakes, Procedures/Techniques/Medication Effectiveness •  Live birth rates according to age groups and time periods Patient centeredness •  Psychological counseling/support available, individualized treatment, patient discussion groups, information, effective communication Efficiency •  Diagnostic work-up prior to IVF, Clinic website with information, number of care providers relative to number of patients Timeliness •  Focus on urgent consultation and waiting time; average duration of waiting time before and during treatment, and after failed attempt Equity •  Explicit criteria for treatment indication, vision of the clinic concerning ethical limitations, protocols in accordance with international/regulatory guidelines Adapted from Dancet et al. HR 2013 ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 34 2014 MARCH ANDROFERT
  35. 35. Top 3 Quality Indicators of Infertility Care How professionals and patients perceive them? Dancet et al. Hum Reprod 2013 0% 20% 40% 60% 80% 100% Doctors/embryologists Nurses Patients Safety Effectiveness Patient-centeredness ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 35 2014 MARCH ANDROFERT
  36. 36. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 36 2014 MARCH ANDROFERT Fertility care providers considered success rates (effectiveness) to be the most important factor, while patients valued the physicians’ attitudes (patient-centeredness) the most
  37. 37. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 37 2014 MARCH ANDROFERT Prove it, but take into account what our needs are!
  38. 38. n Established 2009 n 100 babies born n Few credentials experience n IVF first treatment line n No poor responders n Record of errors/pat. complaints n High multiple PR n Advertise a lot n  Established1994 n  >1,000 babies born n  Lots of credentials/experience n  All treatment options available n  Individualized approach n  Rare errors/patient complaints n  Low multiple PR n  Educational marketing Doctor ‘Look Good’ PR/cycle = 50% ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 38 2014 MARCH ANDROFERT Pregnancy rates not enough Doctor ‘Look Bad’ PR/cycle = 30%
  39. 39. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 39 2014 MARCH ANDROFERT Input Process Output Efficiency indicator Effectiveness indicator Resources Process Mapping
  40. 40. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 40 2014 MARCH ANDROFERT Infertile couple IVF cycle Pregnancy Efficiency indicator Resources Clinic A = 40% Clinic B = 40% Pregnancy Example 1 
 Quality Indicator = Effectiveness
  41. 41. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 41 2014 MARCH ANDROFERT Infertile couple IVF cycle Pregnancy Efficiency indicator Resources Pregnancy Clinic B > A Clinic A = drug 1 Clinic B = drug 2 +3 oocytes retrieved with drug 2 by same dosage Pregnancy (cumulative) Clinic A = 45% Clinic B = 55% Example 1
 Quality Indicator = Effectiveness
  42. 42. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 42 2014 MARCH ANDROFERT Infertile couple IVF cycle Pregnancy (per ET) Efficiency indicator Clinic A = 40% Clinic B = 40% Resources Example 2 
 Quality Indicator = Safety
  43. 43. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 43 2014 MARCH ANDROFERT Infertile couple IVF cycle Pregnancy Efficiency indicator Clinic A = 40% Clinic B = 30% Resources Clinic A = cCOS Clinic B = iCOS Clinic A = 10% Clinic B = 0% OHSS (moderate/ severe) Clinic B > A Example 2 
 Quality Indicator = Safety
  44. 44. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 44 2014 MARCH ANDROFERT Non- obstructive azoospermia IVF cycle Pregnancy Efficiency indicator Clinic A = 40% Clinic B = 30% Resources Example 3 
 Indicator = Patient-centeredness
  45. 45. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 45 2014 MARCH ANDROFERT Non- obstructive azoospermia IVF cycle Pregnancy Efficiency Effectiveness Clinic A = TESE/donor sperm Clinic B = micro-TESE Clinic A = 20% Clinic B = 30% Pregnancy (biological offspring) Clinic B > A Example 3 
 Indicator = Patient-centeredness Resources
  46. 46. Quality cannot be determined by a single parameter such as pregnancy rates Effectiveness, safety and patient-centeredness are amongst the most important quality indicators in infertility care, but the latter is often neglected by doctors/nurses/embryologists TQM offers an opportunity to rethink our systems and fully address all quality dimensions of infertility care, including our customers’ needs Key points (3) ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 46 2014 MARCH ANDROFERT
  47. 47. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 47 2014 MARCH ANDROFERT Patient- centeredness Increase patient satisfaction PregnancyPregnancy Results of satisfaction surveys Safety Reduce errors / mistakes PregnancyPregnancy Number of Non- conformities registered Effectiveness Increase pregnancy rates PregnancyPregnancy Cumulative pregnancy rates Quality Dimension Quality Objective Indicator
  48. 48. ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 48 2014 MARCH ANDROFERT Patient- centeredness Guarantee biological offspring PregnancyPregnancyNo. cases using sperm bank Safety Reduce multiparity and OHSS PregnancyPregnancy No. embryos transferred per cycle; No. cycles using iCOS Effectiveness Increase PRs (biological) in NOA PregnancyPregnancyNo. NOA cases with micro-TESE Quality Dimension Quality Objective Indicator
  49. 49. “The real voyage of discovery consists not in seeking new landscapes, but in having new eyes.” Marcel Proust ANDROFERT androfert.com.br ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 49 2014 MARCH ANDROFERT

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