The document discusses quality in healthcare and three theories of quality: 1) managerial breakthrough theory, 2) continuous improvement theory, and 3) zero defect theory. It explains that healthcare applies all three theories, with continuous improvement theory being the primary approach. Hospitals may apply multiple theories to different departments based on their needs and goals related to quality control, improvement, and standardization. The document also outlines 10 parameters that constitute total quality management in healthcare services and how quality is assessed on the system, process, and outcome levels.

1. Dr. A. Hany Hassanain

2. You’ll know in this lecture:
The three theories of quality
What theories are applied in the healthcare sector
The interrelationship between the three theories
Assessment of quality on different levels

3. Quality Concept
In the healthcare services QUALITY means being effective and efficient in providing the services and being safe at a reasonable economic cost.
It does not mean providing service at any cost for terminal cases

4. What is meant by effective and efficient???

5. Choosing and right thing and doing it right
Taking the right decision & executing it right
Effective & Efficient

6. It stipulates that persons, managers and quality managers have the ability to take the proper decision and they also have the ability to turn these decisions into safe actions that help to achieve the proper target for the mission.
Quality Concept

7. In the ER of a hospital the house officers referred 14 cases to surgery department as acute cases.
They treated 37 cases with different emergency illnesses. The surgeons did 9 operations and discharged 5 patients to be seen in other specialties. The house officers kept 6 persons under observation for 24 hours but 3 asked to be discharged after 2 – 4 hours. 12 patients returned after 2 – 8 hours from the 31 that were treated and discharged after one hour.
Comment on effectiveness and efficiency of the house officers. (10 minutes)
Example

8. Effectiveness = no. of successful decisions / no. of total decisions %
Efficiency = no. of successful work / no. of total work %
Effectiveness & Efficiency

9. Three theories:
1.Managerial Breakthrough  Quality Control + Managerial Breakthrough (improving quality in low sectors) + Planning
2.Cycle of Continuous Improvement  Managerial Responsibility + Managerial Executive Role + Planning
3.Zero Defect  Administration Regulation + Performance Standardization + TQM parameters
Theories of Quality

10. Which theory or theories are applied in the healthcare sector?
Could two or more theories be applied in the same hospital?
The right answer will be commented upon at the end of the lecture

11. Quality Control
Managerial Breakthrough (Improving of low quality sectors)
Planning for Quality
1st Theory – Managerial Breakthrough

12. Quality Control
1.Measuring quality  Quality parameters
2.Defining the quality level of each sector
3.Knowing the lower quality sector or sectors to go to step 2 of the theory

13. Managerial Breakthrough
1.There should be managerial and administrative responsibility to do that.
2.After improving the low quality sector there should be continuous quality improvement not to return backwards.
3.To know the improvement success one should know the performance of workers so one should know about the performance standardization

14. Planning for Quality
1.The management plans for the low quality sector from the low quality parameters to higher quality parameters .
2.From low performance level to higher performance level
3.Anything managerial or administrative should be translated to policies

15. Managerial Responsibility
Managerial Executive Role
Managerial Planning for TQM
Note: The first theory started with control but this started with management
2nd Theory – Cycle of Continuous Improvement

16. Administration regulations
Performance standardization
TQM parameters
Note: It introduced the performance standardization & TQM parameters
Third Theory Zero Defect Theory

17. In Medicine we apply the best available strategy and we use the three theories in different departments and sectors of the hospital but mainly the continuous improvement theory

18. Top Management Workers 2nd Theory Planning 1st Theory Control Breakthrough 3rd Theory Standard Parameters

19. Which theory or theories are applied in the healthcare sector?
Could two or more theories be applied in the same hospital?
The right answer will be commented upon at the end of the lecture

20. Part II

21. Zero Defect Theory
 ICU + Operation Theaters
 Electric Appliances
 Fire Plans
 Surgical Operations
 Invasive Procedures
TQM parameters are imposed after training
Multiple Control Level
Departments & Quality

22. Reliability:
Providing the service without delay with accuracy and the availability of different specialties. This creates a mutual trust. Keeping accurate records is another element of reliability
 Time – Specialties – Records
10 Parameters Constitute the TQM in Health Services

23. Responsiveness:
Rapid response to patients’ needs and the readiness to help them with response to their questions. The patient(s) should be told about the time of service providing.
 Time – Communication

24. Communications:
Between doctors, nurses, secretaries and patients. Availability of information when needed
 Communication methods – Information

25. Understanding:
Of patient’s needs and some of his / her personal problems and the understanding that patients differ in the needs.
 Response to needs when they do not contradict safety

26. Access:
Easy accessibility to the hospital by means of transportation, presence of car barking, and accessibility to the area of service like the outpatient.
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27. Credibility:
Reputation of the hospital, credibility about the outcome of the patient’s condition.
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28. Competence:
The more highly qualified doctors, the more experienced, the more skilled nurses are the more competence for the hospital.
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29. Security:
Safety and secrecy during receiving the medical service. Follow up of the patients.
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30. Empathy:
The priority is for the patient. Some friendship between workers and some chronic patients - Giving the patient the enough time
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31. Tangibles:
Clean building with good design and light color of walls. Good appearance of the staff. Recent equipment - Clean cafeterias - Availability of entertainment equipment.
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32. There are two different standards that should be recognized before TQM program is planned.
Standard measures – could be measured and they represent the work done and the professionally by which it is done.
Desired measures – they represent what patients expect to have from the hospital.
Medical Quality Assessment

33. System Assessment:
Safety measures – number of specialties – nurses / beds - safety of waste removal – infection control – readiness for emergencies, disasters and catastrophes.
Standard Measures – 3 Categories

34. Process Assessment:
Accuracy of Lab, X-ray and other investigations reports – efficiency of methods of diagnosis, efficiency of infection control – drug dispensary forms – protocols of treatment with a special reference to the ER and care units – efficiency of surgical procedures in the hospital compared with other procedures for the same illness.

35. Outcome Assessment:
Mortality and morbidity studies – level of complications – cure rate for curable diseases – hospital acquired infection level – hospital stay days comparing with standards for the same illness.

36. Expectation of patients: complaint – surveys – personal meetings.
Perception of patients: the appreciation level of the service - when the patient is discharged s/he may fill a form about level of the service.
The Desired Measures

37. Perception of the hospital’s workers: Questionnaires and surveys to answer the question of what the administration expect from the patients.
They do not reflect the appreciation of workers

38. Absentees
Conflicts
Surveys
Leaving the place
 Not following the instructions
Informal organizations
Strikes
Worker’s Satisfaction

39. What was best in the lecture and what was worst:
A. The teaching part – rank from 1 (worst), 2, 3, 4(best)
B. The Discussion – 1 (worst), 2, 3, 4 (Best)
C. The workshop – 1 (worst), 2, 3, 4 (Best)
D. The Exercise – 1 (worst), 2, 3, 4 (Best)
E. Did you feel bored during the lecture – Yes or No
F.Do you have better understanding of the healthcare business and how it was developed and how will it be developed in the future? Yes or No
Please Rank the Lecturer

40. Thank You