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QUALITY ASSURANCE IN
      HOSPITAL




             DR. N. C DAS
QUALITY ASSURANCE SYSTEM

Quality assurance is a range of activities (including review, evaluation,
surveillance, appraisal and monitoring) which collectively comprise the
intelligence gathering arm of quality assurance.
These are:-
 * Quality consists of doing those things necessary to meet & exceed the
needs & expectations of those we serve & doing those right things right
every time . * * * *Review is the process of critical reflection used by
clinicians wishing to assess their own (or their peers') performance
* Audit is the activity of review when conducted on a continuous and
routine basis.
* Evaluation is one-off assessment of the impact of a service on indices of
health
* Surveillance is routinely repeated evaluation
* Appraisal is ad hoc data collection and analysis by management in
relation to health care delivery
* Monitoring is ongoing appraisal
QUALITY

QUANTUM

UPHOLD

ASSURED

LEVEL

IN
TEST

YEILD
           Dr.N.C.DAS
WHAT IS QUALITY

Quality is not a number but is a function of positive perception.
Quality, simplistically, means that a product should meet one‟s
requirement.
Quality is the inherent characteristic & distinctive attribute that
makes a product different from others.
Ensures conformity to requirement.
Products & services should be essentially free from defects ,
there by becoming cost effective.
Quality consists of doing those things necessary to meet &
exceed the needs & expectations of those we serve & doing those
right things right every time .
It is the result of good intention, sincere effort, intelligent
thinking and skillful execution.
All dimensions like accessibility, appropriateness, continuity,
effectiveness & efficiency must be given equal importance in
quality.
QUALITY MANAGEMENT

“It is a holistic approach to the art of
managing quality output considering
together the people, process and products
rather than independent factors and driven
towards the objective with effective &
efficient performance output”.


                                  DR. N.C DAS
QUALITY REQUIREMENTS

1.Customer participation in QM;
2. Leadership for the steering of quality;
3. Personnel as a prerequisite for high quality;
4. QM for preventive as well other activities;
5. Management of processes as a basis for QM;
6. Information as a basis for the continuous
enhancement of quality;
7. Systematisation of QM;
8. Feed back and detailed recommendations;
9. Quality criteria support quality management;
WHY QUALITY
Rapid advance in Health care sector.
Rapid development in diagnostic and operation technology.
Increased awareness of people about health.
Stiff market competition.
Improved communication technology and roll of Media.
The service is for allouring the pain, sickness and disease.
The service is patient centric and person specific.
Provided by a team of highly skilled to non skilled group of
doctors, nurses and other medical staff.
The type of function is multi centric and multifaceted.
The over all objective is good patient care up to their level of
satisfaction.
There is only one answer to this --- A good quality systematic
Health care by developing a carefully planned hospital
quality management system..
QUALITY ASSURANCE
      SYSTEM
    DR. N. C. DAS
QUALITY

QUANTUM

UPHOLD

ASSURED

LEVEL

IN
TEST

YEILD
           Dr.N.C.DAS
WHAT IS QUALITY

Quality is not a number but is a function of positive perception.
Quality, simplistically, means that a product should meet one‟s
requirement.
Quality is the inherent characteristic & distinctive attribute that
makes a product different from others.
Ensures conformity to requirement.
Products & services should be essentially free from defects ,
there by becoming cost effective.
Quality consists of doing those things necessary to meet &
exceed the needs & expectations of those we serve & doing those
right things right every time .
It is the result of good intention, sincere effort, intelligent
thinking and skillful execution.
All dimensions like accessibility, appropriateness, continuity,
effectiveness & efficiency must be given equal importance in
quality.
DIFFERENT PERCEPTION OF QUALITY

       PROVIDER                      RECEIVER                    ORGANISER
• To provide care as per     • Accessibility                • Social Equity
  established norms          • Affordability                • Effective public
• Doing the right thing                                     resource utilization
                             • Prompt attention
• Doing it the right way                                    • Standardised care
• Doing it right the first   • Less waiting time            • Cost contentment
  time                       • Receiving the right          •Satisfaction of both
• Doing it on time             service for their use        provider and receiver
  without exceeding cost     • Being satisfied that their   • Fruitful outcome
• Availability of              needs have been met          • Profit margin
  Adequate resources         • Early cure and return to
• Satisfaction with the        work
  final outcome              • Being treated with
• Helps in improving            integrity, courtesy and
  skills, efficiency and        respect
  experience
DIMENTIONS OF QUALITY
Joint commission on Accreditation of Health care organisations (JCAHO) has
described the following criteria's as quality dimensions
(safety, effectiveness, efficiency, timeliness, efficacy and equity
Respect and caring, availability, appropriateness),



                                RESPECT AND
              SAFETY                                    TIMELINESS
                                  CARING




            EFFICACY            EFFECTIVENESS            EFFICIENCY




                                                      APPROPRIATENES
            CONTINUITY            AVAILABILITY           S/ EQUITY
WHY QUALITY IS NEEDED
Rapid advance in Health care sector.
Rapid development in diagnostic and operation technology.
Increased awareness of people about health.
Stiff market competition.
Improved communication technology and roll of Media.
The service is for allouring the pain, sickness and disease.
The service is patient centric and person specific.
Provided by a team of highly skilled to non skilled group of
doctors, nurses and other medical staff.
The type of function is multi centric and multifaceted.
The over all objective is good patient care up to their level of
satisfaction.
There is only one answer to this --- A good quality systematic
Health care by developing a carefully planned hospital
quality management system..
ADVANTAGE OF QUALITY

– Reduction in             • Improved care
  wastage                  • Shorter lead times
– Better team spirit       • Better relationship with
– Less staff conflict,       customers
  enhanced job             • Reduced cost, increased
  satisfaction               profit
– Increased efficiency     • Improved systems and
– Confidence to              standardized procedures
  clients,                 • Better workmanship,
– less customer            • Guaranteed quality
  complaints,
– lower rejection rates,
  less rework
QUALITY REQUIREMENTS

1.Customer participation in QM;
2. Leadership for the steering of quality;
3. Personnel as a prerequisite for high quality;
4. QM for preventive as well other activities;
5. Management of processes as a basis for QM;
6. Information as a basis for the continuous
enhancement of quality;
7. Systematisation of QM;
8. Feed back and detailed recommendations;
9. Quality criteria support quality management;
PARTS OF THE QUALITY SYSTEM

     Organization   Personnel    Equipment



                      Process
     Purchasing       Control    Information
                    (QC & EQA)
     & Inventory    & Specimen
                                 Manageme
                    Management        nt


     Documents      Occurrence
                    Management   Assessme
     & Records
                                    nt



       Process      Customer     Facilities &
     Improvement     Service       Safety


                                                CDC
COMPONENTS OF QUALITY
           SYSTEM
       PROMOTING QUALITY                                    CORRECTING QUALITY




                                  QUALITY SYSTEM
Determination       Promotion                            Policy and          Beneficiaries
                        of                                                  empowerment
  of Quality                                            management
                    standards                                                     and
 requirement           and                                decision
                                                          making             participation
                    guidelines


                    Regulations                    Health
      Management                                   outcomes
      systems for
                      Payment                                          Quality
                                                   Practices          monitoring
        quality     System mgt.                    Satisfaction
                    Information                    Complaints
HOSPITAL QUALITY SYSTEM

                 QYALITY SYSTEM




   INTERNAL                           EXTENAL
QUALITY SYSTEM                     QUALITY SYSTEM

ORG STRUCTURE                     HOSPITAL ACREDITATION
SAFETY, EFFECTIVENESS,            ISO CERTIFICATION
EFFICIENCY, TIMELINESS,           EXTERNAL MEDICAL
PATIENT-FUCUSED EQUITY            AUDIT
COMPONENTS OF INTERNAL
              QUALITY SYSTE

                                     OUTCOMES
STRUCTURE      PROCESSES
                                     OF CARE
   INPUTS          STEPS                 OUTPUTS

•Patients       •Inventory Methods   •Physiologic
•Equipment      •Coordination         parameters
•Supplies       •Physician orders    •Functional status
•Training       •Nursing Care
•Environment    •Ancillary staff               OUT COME
                •Housekeeping
                •Transport                 • Patient
                                           Satisfaction
                                           •Cost
INPUT---PROCESS----OUTPUT
A. INPUT
   Input is what we invest
    inputs are the various needs and resources that projects can draw upon as
   it sets out to accomplish its work.
    Inputs include resources like manpower, data, and money and materials.
B. PROCESS
   Process is the ensemble of activities of planning , implementing and
   monitoring the performance of an activity.
   Process manipulates the inputs to get the output.
   It include functions, actions, and operations.
   Process management is the application of knowledge, skills, tools,
   techniques , and systems to define, visualize, measure, control, report and
   improve processes with the goal to meet customer requirements.
C. OUTPUT
    Outputs, are the results of processes, which include products, information,
   and reports.
    It disseminate (output) data and information and provide a feedback
   mechanism to meet an objective.
    Outputs are the results of processes.
D. OUTCOME
•It is the Impact of a process.
•It may be a level of performance, or achievement.
•It may be associated with the process, or the output.
Outcomes imply quantification of performance.
Outcomes imply quantification of performance.
It may include cost reduction , Product appreciation or client satisfaction.
The out come may be:-
          Short Term (learning: awareness, knowledge, skills, motivations)
          Medium Term (action: behavior, practice, decisions, policies)
          Long Term (consequences: social, economic, environmental etc.)
INTERNAL QUALITY SYSTEM

     IN PUT                    PROCESS                      OUTPUT

                                                         i). QUALITY
i). PERSONNEL              i). SOP                        Error of
ii) MATERIAL               ii). INTER                    treatment./Death
iii) SUPPLIES              PERSONAL                       Complication
iv). FINANCE
v). TECHNOLOGY
                           RELATION                      LAMA, AVLS
vi). RULES AND             iii). ART OF CARE             ii). QUANTITY
   REGULATIONS             iv). MANAGEMENT                BTR, BOR, OT
                           TECHNIQUES                    Disability
                           v).DOCUMENTATION              iii). COST
                                                         iv). CONSUMER
                                                         SATISFACTION




                  INPUT         PROCESS        OUT PUT
                 CONTROL        CONTROL        CONTROL
COMPONENTS OF QUALITY SYSTEM
1. INPUTS
•Adequate buildings and working space
•Necessary equipments always available and functioning
•Necessary medications and medical supplies always available
•personnel
•Anybody who touches the patient or a relevant process in the system:-
Departments, physicians, clerks, pharmacy, nursing, OT, ICU, care technicians,
phlebotomist, patient transport, administration
2. PROCESSES
•All those affecting relevant aspects of patient care:-
Clinical decision making, order writing, admission intake, medication delivery,
direct patient care, discharge planning, communication, discharge follow-up, etc
3. 4. OUTPUT
•Which are the end result of the process :-
Physiologic parameters, (Meeting standards )
functional status, (Efficiency, Effectiveness, Quality)
5. OUTCOME
Which are the end result of the output
Patient satisfaction ,Cost
QUALITY SYSTEM


Quality does not happen by chance
Quality needs to be systematically
developed
With objective planning, staff
involvement and considering patient
need.
DEVELOPING A QUALITY SYSTEM



       Quality system
       Quality Manual
       Quality procedures
       Quality plan
       Quality audit
QUALITY SYSTEM

STAGE 1 –
Chief executive of the firm should commit to quality assurance by
declaring quality policy e.g. „Towards total customer satisfaction‟
Make formal statement of the objectives e.g. „ To achieve ISO 9002
certification in 18 months‟
Organizing management structure and defining responsibilities
following the above activities
STAGE 2 –
Examine and review the existing internal documentation, activities and
procedures prior to preparation of quality manual and quality
procedures i.e. quality system
STAGE 3 –
Apply general quality procedures to specific contracts when the quality
system is completed and fully approved internally.
Staff should be familiar with quality assurance and understand their
roles but training is required.
QUALITY SYSTEM

STAGE 4 –
Prepare quality plans and additional quality procedures
for specific contracts.
STAGE 5 –
Apply quality plans to specific contracts. Training may be
necessary.
STAGE 6 –
Internal and external audit of quality system; review
periodically all quality manuals and procedures.
QUALITY MANAGEMENT

It is a holistic approach to the art of
managing quality output considering
together the people, process and
products rather than independent
factors and driven towards the
objective with effective & efficient
performance output.
ELEMENTS OF QUALITY
                MANAGEMENT
Errors in the hospital are invariably due to system failure in85% of
cases(Edward Deming).
Only 15% are attributed to people‟s performance.
Therefore attention should be given on bad system than bad people.
Improvement of systemic errors can be done by:-
Commitment of TOP Management,
Active support of Middle Management.
Education and training of staff.
Formation of quality management team.
Developing Quality culture in the work place.
Making aware all staff about the goal and objective of the organisation.
Developing quality policy and quality manual.
Developing Standard Operating Procedure for all areas (SOP) .
Good Hospital Information System (HIS).
Formulation of criterias and Standards for Measuring activities.
Constant monitoring and Supervision and feed back.
Introducing Medical Audit System.
Rectification of errors and Evaluation.
External quality control.
COMPONENTS OF QUALITY MANAGEMENT SYSTEM

   QUALITY                      QUALITY
  PLANNING                      CONTROL




                 SYSTEM




                PATIENT NEED
   QUALITY      SATISFACTION    QUALITY
IMPROVEMENT                    ASSURANCE

               TOTAL QUALITY
               MANAGEMENT
COMPONENTS OF QUALITY PLANNING

POLICY STATEMENT                    RISKS AND
   ON QUALITY                   RISK MANAGEMENT




                    PLANNING
  RECORDS AND
 DOCUMENTATION                   QUALITY MANUAL




WORK INSTRUCTION
       OR
  WORK SHEET                           SOP
4 TIER QMS DOCUMENTATION

                      QUALITY MANUAL
TIER-1
              (objectives, policies, philosophies)


                         PROCEDURES MANUAL
   TIER-2
                         (purpose, scope, standard)



                               JOB INSTRUCTIONS
         TIER-3
                       (work sheet/specific work instructions)



             TIER-4                   FORMS & RECORDS
QUALITY MANUAL CONTENTS
  AIMS AND      STANDARDS                        LEVEL OF
                                    MANAGEMENT
 OBJECTIVES    AND CRITERIA
                                      SYSTEM     CONTROL



 CORECTION                                           JOB
    AND                                          DESCRIPTION
 EVALUATION
                          QUALITY
                          MANUAL
 MONITORING                                      DEVELOPING
    AND                                              HIS
 SUPERVISION




   QUALITY         QUALITY            ORGN.       TRAINING
MEASUREMENTS     DIMENTIONS          ANALYSIS
1.ORGANISATIONAL ANALYSIS
Organisation structure must meet the organisational functions and Objectives.
Review organisational relationship with its external environment.
Analyse organisational structure with respect to Hierarchy, span of control ,
Authority and delegation.
Functions, Work distributions and accountability.
Identify Problem areas, analyse to understand the „Cause and Effect‟ for suitable
remedial measures.
2. TRAINING
Train the management about quality System.
Train the Quality monitoring team.
Training of staff how to maintain quality at work place and their specific roll.
3. DEVELOP HIS
i) Hospital operation Statistics.
     - Hospital Resources and their utilization.
     - Administrative and financial data.
ii). Hospital Morbidity Statistics.
     - Patient characteristics
     - AVLS, BTR, BOR, Infection rates.
     - Consultations, complications and Errors.
     - Type of treatment, investigations.
     - Outcome of hospital stay, Events, Death/ Discharge.
FORMULATION OF CRITERIA AND
       STANDARDS

 INDICATRES              AREAS
 Prevention              Ambulatory care sensitive
 Quality Indicators      Conditions, House keeping,
                         HIC. BMW disposal.
 Inpatient Quality       Mortality following
 Indicators ( PROCESS)   procedures
                          Mortality for medical
                         conditions
                         Utilization of procedures
                         Volume of procedures
 Patient Safety          Post-operative
 Indicators              complications
                         Iatrogenic conditions/Errors.
SERVICE QUALITY MEASUREMENT

  STRUCTURE            PROCESS             OUT COME

                                        i). QUALITY OF CARE
i). STRUCTURE      i). PHYSICIAN AND    ERRORS
DESIGN             PATIENT              INFECTIONS
ii). RESOURCES     INTERACTION          DEATHS
-BEDS              ii). INTER-          ii). QUANTITY OF
-PERSONNEL         PERSONAL             CARE
-- SUPLIES         RELATION             No. OF PATIENTS
-- Finance                              TREATED
                   iii). TECHNIQUES
                                        NO. OF OPERATION
-- EQUIPMENTS      AND                  NUMBER OF PATIENT
-- SPACE            PROCEDURES           REFUSED ADMISSION
iii). TECHNOLOGY   iv). TOTAL QUALITY   Iii). COST OF CARE
iv). RULES         MANAGEMENT           COST PER BED
v). PROCEDURES     (TQM)                COST PER PATIENT
                                        iv). PATIENT
                                         SATISFACTION
TYPICAL QUALITY RECORDS


QS Elements          ISO 9001   Quality Records
                     ref:
Mgt responsibility   4.1        Mins. of mgt review
Quality system       4.2        QM,PM, PQP,JI/SWI
Contract review      4.3        Mins. of tender review
Design control       4.4        Design plan, inputs,…
Doc & data control   4.5        Register-files, sigs,revs
Purchasing           4.6        Register of acceptable subs
Control of Cost      4.7        Cost verification records
QS Elements           ISO 9001 ref: Quality Records
Ident & Traceable     4.8           Product/batch records
Process control       4.9           MS, stds, qualifications
Inspection & Testing 4.10           ITP, insp reports
Control of insp,      4.11          Register of equipments and
measuring & test                    cal. certificates
equip
Insp. & Test status   4.12          Job cards, progress insp
                                    rep.
Control of complains 4.13           Com reports, defects
                                    reports
Corrective & Prev A   4.14          Corrective action reports
QS Elements             ISO 9001 ref: Quality Records
Hdlg, storage,          4.15          Delivery notes, dispatch
packaging, presv, del                 advices
Control of quality      4.16          Insp./test reports, audits
records                               reports
Internal quality audits 4.17          Audit reports, CAR
Training                4.18          Qualification records,
                                      training course records
Servicing               4.19          Visit reports, maint. Logs,
Stats. techniques       4.20          Control charts
QUALITY CONTROL
•QC is product oriented Activity
•Quality Control (QC) is a system of routine technical evaluation, to
measure and control the quality of the product as it is being developed.
•A set of activities designed to evaluate a finished work product/service.
•QC activities focus on finding defects in specific out puts - e.g., are the
defined requirements the right requirements have been met.
•QC is set of activities whose purpose is to ensure that all quality
requirements are being met that is defect detection, and done by testing
•Quality Control is mainly an inspection function.
•QC is product/output Oriented Activity
•It is a processes and methods used to compare product quality to
requirements and applicable standard
•Action taken when a non conformance is detected
QUALITY CONTROL

     Evaluation of planned or systemic actions to provide enough
     confidence that a product or service has satisfied the given
     requirements of quality as pre- determined.

                   IDENTIFY THE SERVICE/ PRODUCT


                         MATCH INDICATORS

                      COMPARE WITH ESTABLISH
                            STANDARD


                         EVALUATE OUTPUT




QUALITY ACHIEVED                                        QUALITY NOT ACHIVED

                                                        REVIEW THE PROCESS &
  ENHANCE STANDARD                                      AREAS OF IMPROVEMENT
QUALITY ASSURANCE
•QA is process oriented Activity
•It is a planned system of monitoring procedures of process conducted
by personnel not directly involved in the inventory compilation/development
process.
•A set of activities designed to ensure that the development and/or
maintenance process is adequate to ensure a system will meet its
objectives.
•QA activities ensure that the process is defined and appropriate.
Methodology and standards development are examples of QA activities.
•A QA review would focus on the process elements of a project - e.g., are
requirements being defined at the proper level of detail.
•QA is set of activities whose purpose is to demonstrate that an entity
meets all quality requirements.
•This is done by adopting a standard set of process and usual QA
techniques like review, training, facilitation etc.
•It can be termed as defect prevention.
•Quality assurance is an audit function.
QUALITY ASSURANCE


        •A set of activities designed to ensure that the development
        and/or maintenance process is adequate to ensure a system
        will meet its objectives.


    INPUT                      PROCESS                      OUTPUT


   IDENTIFY THE
                           PUT THE SYSTEM          MONITOR THE OUTPUT
     PROCESS
                           INTO ACTION AND            STANDARD AND
SET THE PROTOCOL           MONITOR AS PER              COMPARE TO
                                 SOPs               SET QUALITY LEVEL
 PREPARE SOP

  SET QUALITY
     LEVEL
QUALITY CONTROL vs. ASSURANCE

     QUALITY CONTROL                               QUALITY ASSURANCE
                                               •
•   QC is product oriented Activity
                                                   QA is process oriented Activity
                                               •   A set of activities designed to ensure
•   A set of activities designed to evaluate
                                                   that the development and/or
    a developed work product.
                                                   maintenance process is adequate to
•   QC activities focus on finding defects         ensure a system will meet its
    in specific deliverables - e.g., are the       objectives
    defined requirements the right
                                               •   It ensure that the process is defined
    requirements
                                                   and appropriate. Methodology and
•   After manufacturing the product, the           standards development are examples
    quality control process begins.                of QA activities.
•   quality control follows the guidelines     •   It focus on the process elements of a
    and standards established by                   project - e.g., are requirements being
    assurance of quality department to             defined at the proper level of detail.
    check whether output meet the quality
                                               •   is meant to produce defect-free goods
    requirements or not.
                                                   or services which means being right
•   Depending upon the results, suitable           the first time with no or minimum
    corrective action is taken by quality          rework.
    control personals.
QUALITY CONTROL vs ASSURANCE
      QUALITY CONTROL                             QUALITY ASSURANCE
•   Quality control ensures that these        •   quality assurance process is a series of
    defined standards are followed at             steps taken at the different stages of the
    every step.                                   product life cycle i.e. from the product
                                                  concept to the launch of the product to its
•   It is focused on detecting the defects        obsolescence.
    once the product is manufactured.         •   Assurance of quality is a set of preventive
•   Quality control is a failure detection        activities, which are focused on processes
    system that uses a testing technique      •   Assurance defines the standards to be
    to identify errors or flaws in products       followed
•   some process parameters cannot be         •   Quality guarantee department develops all
                                                  the planning processes and procedures to
    controlled and here is where quality
                                                  make sure that the output is of good quality
    control comes into picture.
                                              •   Assurance of quality is a failure prevention
•   Quality control is a corrective process       system that predicts safety, quality
•   The processes of quality control              standards and legality
    involve calibration, sampling and         •   Quality guarantee processes involve
    documenting reviews and giving                implementing real-time quality checks in
    feedback for improvement                      every department
                                              •   It is a monitoring process
•    It is an Evaluation process
QUALITY IMPROVEMENT
Maintaining the process of quality standards through
out and efforts made to improve upon is termed as
„continuous quality improvement‟.
Continuous quality improvement is therefore a key
component of successful management technique.
There are four “quality improvement initiatives” that
hospitals could use as a yardstick to achieve the best
outcomes:-
 Nurses must be actively involved throughout the
process,
 Quality outcomes should be transparent,
 Decisions must be supported by quality research,
 Staff should feel empowered to make decisions and
be held accountable
QUALITY IMPROVEMENT PLAN

           The quality improvement plan emphasizes on three
           aspects for continuous improvement

                                        SYSTEM
SERVICE/PRODUCT                                                          PEOPLE‟S
  IMPROVEMENT                                                          IMPROVEMENT



1.   Quality of supplies
2.   Sterile procedure                                         1. Motivation & leadership
3.   Working Environment               PROCESS                 2. In service training & skill
4.   Proper maintenance of           IMPROVEMENT               developments.
     records                                                   3. Awards & recognition
5.   SOPs                                                      4. Seminar & work shops
                                   Inpatient Quality
6.   Use of latest technique for                               5. Empowerment of people
                                   Indicators (IQIs)
     separation                    Prevention Quality
                                   Indicators (PQIs)
                                   Patient Safety Indicators
                                   (PSIs)
COMPONENTS OF IMPROVEMENT
A. SERVICE IMPROVEMENT
     Can be done through introducing latest technology and machines
     Ensuring supplies at right time at right place in right quantity.
     Regular maintenance and standardisation of equipments.
     Implementing standard operating procedure.
B. PROCESS IMPROVEMENT
    Introducing suitable modern management techniques
    Follow ISO certification guide lines
    Get the certification from NABH
    Define clear cut job responsibilities.
    Fix accountability.
    Detect problems early and solve it.

C . PEOPLES IMPROVEMENT
    Develop regular staff training program
    Onsite training of staff at work place.
    Develop staff work culture
    Introduce quality circle discussions.
    Inculcate team spirit, leadership and motivation among workers.
TOTAL QUALITY MANAGEMENT


T – Take the entire organization, patient, staff and its activities
into consideration.


Q – Quantum output to meet pre- determined standard/
objective.


M – Manage step by step i.e. Planning, Organizing, Controlling,
Provisioning, Staffing.
•Determine goals & priorities                    .Apply the plan
•Determine processes                        •Train & educate the workers
•determine tracking indicators              •Monitor tracking indicators




   •Take action to eliminate any problems
   •Standardize process if successful         •Check results of
   •If not Plan future improvements           implemented plan
                                              •Identify any problems


                         TQM CYCLE
WHAT IS TOTAL QUALITY MANAGEMENT

Total Quality Management is that aspect of the overall management
function that determines and implements the quality policy.
1. It is a business management strategy aimed at embedding
awareness of quality in the entire organizational process.
2. It is defined as a combination of organization functions and
management techniques centered on quality, based on the
participation of all members focusing on long term success
through meeting customer needs, satisfaction and
organizational objective.
3. Quality management takes in to consideration PEOPLE,
PROCESS and PRODUCT
       When along with these three elements Patients need is also taken into
    consideration
        It is termed as „TOTAL QUALITY MANAGEMENT‟
OBJECTIVE:      Do the right things, right the first time, every time and
reduce losses due to wasteful practices.
FOUR “Ps” OF TQM
  Peoples                  Process
Commitment               Improvement




                  TQM




Patients Need               Product
 Satisfaction
                            In time
PRINCIPLES OF TQM
C – Commitment by top management
O – Organization and structure for TQM
N - Normal financial control activities
S – Supplier relationships initiative
T – Training, education and safety awareness of staff
R – Relationships cordial with customers
U – understanding and commitment by employees
C – Communications net working
T – Teamwork encouragement
I – Independent certification level to ISO 9000
O – Objective measurement of functions
N – Natural use of tools and techniques and skills
SUCCESS OF TOTAL QUALITY MANAGEMENT

                      TQM
MANAGEMENT AND      CULTURE
                                   EMPLOYEE
STAFF COMMITMENT
                                 EMPOWERMENT




  LEADERSHIP
      AT              TQM           QUICK
     TOP            SUCCESS       RESPONSE




                                   FACT BASED
 CUSTOMER                           DECISION
   FOCUS                             MAKING


                     CONTINOUS
                   IMPROVEMENT
DEVELOPING TQM CULTURE
All departments of the hospital were asked to compile a list of
quality problems
Review of the list by the Hospital Quality Committee
Provide feedback to the departments and support departments for
the analysis of problems and design of solutions
HOSPITAL QUALITY COMMITTEE
Establish a Comprehensive quality plan for the Hospital in close
cooperation with departments
Initiate, coordinate and support Quality Groups in the various
hospital departments
To give advice to Quality Groups for developing their action plans
Support implementation of action plans of the Quality Groups
Motivation and appraisal of Quality Groups
Feedback to Hospital Management Team
Establish quality circles in all departments
Train more staff with QM skills
Work on the problems with each department
QUALITY CIRCLES(QC)
• SIGNIFICANCE OF QC:
I.  UTILISING EDUCATION,EXPERIENCE AND CREATIVITY.
•   QC –AN INTEGRATED PROGRAMME:
1. MEMBERS
2. CIRCLE LEADERS
3. FACILITATORS
4. CO-ORDINATOR
5. STEERING COMMITTEE
•   PROCESS
a) PROBLEM IDENTIFICATION
b) PROBLEM SELECTION
c) PROBLEM ANALYSIS
d) IMPLEMENTATION &RECOMMENDATION TO THE
    MANAGEMENT.
    QC ENVISAGES PARTICIPATORY MANAGEMENT STYLE
    WITH A “BOTTOM UP” APPROACH.
TQM - CULTURE
COMMITMENT TO
MANAGEMENT OF        REDUCE        MEETING
  EMPLOYEES        PROCESSING     COUSTOMER
                  TIME AND COST      NEED



                                    FINISH IN
     SET                          PREDETERMINE
  NEW TARGET                          TIME
                      TQM
                    ACTIVITIES
                                    CUSTOMER
 RECOGNITION                       SATISFACTION
  & AWARD


                     IMPROVE        IMPROVE
  EMPLOYEES
 EMPOWERMENT           PLAN          SYSTEM
QUALITY MANAGEMENT vs. TQM
Quality element   Previous state (Traditional)   Total Quality Management
Definition        Product oriented               Customer oriented

Priorities        Second to service and Cost     First among the equals of
                                                 service and cost

Decisions         Short term                     Long term




                                                                                   Source: Basterfieldet al, 2002 pp3)
Emphasis          Detection                      Prevention
Errors            Operations                     System

Responsibility    Quality Control                Every one

Problem solving   Managers                       Teams

Procurement       Price                          Life cycle costs, partnership


Manager‟s Role    Plan, assign, control and      Delegate, coach, facilitate and
                  enforce                        mentor
• Inadequate financing             • Inadequate M3
• An expenditure and not           • Large gap between demand &
investment                         supply
• No regionalisation of Med        • Lack of motivation, misuse &
care policy                        pilferage.
• No strict referral system        • Poor budgetary planning
• Political and beaurocrate        •Unionism internal conflicts
interference                       • Lack of latest gadgets
• Lack of regular re-orientation   • Poor handling Of
• training in advancement of       grievances/complaints
technology                         • Lack of standing
                                   guidelines/procedures
                                   • evaluation of care from
                                   patient/relatives         DR.N.C.DAS
QUALITY DIAMOND
                 (FOUR ELEMENTS OF QUALITY SERVICE)

                           CUSTOMER
                          SATISFACTION



   CONTINUITY                                    COMMITMENT
IN IMPROVEMENT                                    OF STAFF
                           QUALITY
                           DIAMOND




                          EXPECTATION
                           OF PATIENT
                           AND STAFF
hospiad
  Hospital Administration Made Easy




           http//hospiad.blogspot.com
An effort solely to help students and aspirants
   in their attempt to become a successful
           Hospital Administrator.
                                           DR. N. C. DAS

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Quality Assurance in Hospitals

  • 1. QUALITY ASSURANCE IN HOSPITAL DR. N. C DAS
  • 2. QUALITY ASSURANCE SYSTEM Quality assurance is a range of activities (including review, evaluation, surveillance, appraisal and monitoring) which collectively comprise the intelligence gathering arm of quality assurance. These are:- * Quality consists of doing those things necessary to meet & exceed the needs & expectations of those we serve & doing those right things right every time . * * * *Review is the process of critical reflection used by clinicians wishing to assess their own (or their peers') performance * Audit is the activity of review when conducted on a continuous and routine basis. * Evaluation is one-off assessment of the impact of a service on indices of health * Surveillance is routinely repeated evaluation * Appraisal is ad hoc data collection and analysis by management in relation to health care delivery * Monitoring is ongoing appraisal
  • 4. WHAT IS QUALITY Quality is not a number but is a function of positive perception. Quality, simplistically, means that a product should meet one‟s requirement. Quality is the inherent characteristic & distinctive attribute that makes a product different from others. Ensures conformity to requirement. Products & services should be essentially free from defects , there by becoming cost effective. Quality consists of doing those things necessary to meet & exceed the needs & expectations of those we serve & doing those right things right every time . It is the result of good intention, sincere effort, intelligent thinking and skillful execution. All dimensions like accessibility, appropriateness, continuity, effectiveness & efficiency must be given equal importance in quality.
  • 5. QUALITY MANAGEMENT “It is a holistic approach to the art of managing quality output considering together the people, process and products rather than independent factors and driven towards the objective with effective & efficient performance output”. DR. N.C DAS
  • 6. QUALITY REQUIREMENTS 1.Customer participation in QM; 2. Leadership for the steering of quality; 3. Personnel as a prerequisite for high quality; 4. QM for preventive as well other activities; 5. Management of processes as a basis for QM; 6. Information as a basis for the continuous enhancement of quality; 7. Systematisation of QM; 8. Feed back and detailed recommendations; 9. Quality criteria support quality management;
  • 7. WHY QUALITY Rapid advance in Health care sector. Rapid development in diagnostic and operation technology. Increased awareness of people about health. Stiff market competition. Improved communication technology and roll of Media. The service is for allouring the pain, sickness and disease. The service is patient centric and person specific. Provided by a team of highly skilled to non skilled group of doctors, nurses and other medical staff. The type of function is multi centric and multifaceted. The over all objective is good patient care up to their level of satisfaction. There is only one answer to this --- A good quality systematic Health care by developing a carefully planned hospital quality management system..
  • 8. QUALITY ASSURANCE SYSTEM DR. N. C. DAS
  • 10. WHAT IS QUALITY Quality is not a number but is a function of positive perception. Quality, simplistically, means that a product should meet one‟s requirement. Quality is the inherent characteristic & distinctive attribute that makes a product different from others. Ensures conformity to requirement. Products & services should be essentially free from defects , there by becoming cost effective. Quality consists of doing those things necessary to meet & exceed the needs & expectations of those we serve & doing those right things right every time . It is the result of good intention, sincere effort, intelligent thinking and skillful execution. All dimensions like accessibility, appropriateness, continuity, effectiveness & efficiency must be given equal importance in quality.
  • 11. DIFFERENT PERCEPTION OF QUALITY PROVIDER RECEIVER ORGANISER • To provide care as per • Accessibility • Social Equity established norms • Affordability • Effective public • Doing the right thing resource utilization • Prompt attention • Doing it the right way • Standardised care • Doing it right the first • Less waiting time • Cost contentment time • Receiving the right •Satisfaction of both • Doing it on time service for their use provider and receiver without exceeding cost • Being satisfied that their • Fruitful outcome • Availability of needs have been met • Profit margin Adequate resources • Early cure and return to • Satisfaction with the work final outcome • Being treated with • Helps in improving integrity, courtesy and skills, efficiency and respect experience
  • 12. DIMENTIONS OF QUALITY Joint commission on Accreditation of Health care organisations (JCAHO) has described the following criteria's as quality dimensions (safety, effectiveness, efficiency, timeliness, efficacy and equity Respect and caring, availability, appropriateness), RESPECT AND SAFETY TIMELINESS CARING EFFICACY EFFECTIVENESS EFFICIENCY APPROPRIATENES CONTINUITY AVAILABILITY S/ EQUITY
  • 13. WHY QUALITY IS NEEDED Rapid advance in Health care sector. Rapid development in diagnostic and operation technology. Increased awareness of people about health. Stiff market competition. Improved communication technology and roll of Media. The service is for allouring the pain, sickness and disease. The service is patient centric and person specific. Provided by a team of highly skilled to non skilled group of doctors, nurses and other medical staff. The type of function is multi centric and multifaceted. The over all objective is good patient care up to their level of satisfaction. There is only one answer to this --- A good quality systematic Health care by developing a carefully planned hospital quality management system..
  • 14. ADVANTAGE OF QUALITY – Reduction in • Improved care wastage • Shorter lead times – Better team spirit • Better relationship with – Less staff conflict, customers enhanced job • Reduced cost, increased satisfaction profit – Increased efficiency • Improved systems and – Confidence to standardized procedures clients, • Better workmanship, – less customer • Guaranteed quality complaints, – lower rejection rates, less rework
  • 15. QUALITY REQUIREMENTS 1.Customer participation in QM; 2. Leadership for the steering of quality; 3. Personnel as a prerequisite for high quality; 4. QM for preventive as well other activities; 5. Management of processes as a basis for QM; 6. Information as a basis for the continuous enhancement of quality; 7. Systematisation of QM; 8. Feed back and detailed recommendations; 9. Quality criteria support quality management;
  • 16. PARTS OF THE QUALITY SYSTEM Organization Personnel Equipment Process Purchasing Control Information (QC & EQA) & Inventory & Specimen Manageme Management nt Documents Occurrence Management Assessme & Records nt Process Customer Facilities & Improvement Service Safety CDC
  • 17. COMPONENTS OF QUALITY SYSTEM PROMOTING QUALITY CORRECTING QUALITY QUALITY SYSTEM Determination Promotion Policy and Beneficiaries of empowerment of Quality management standards and requirement and decision making participation guidelines Regulations Health Management outcomes systems for Payment Quality Practices monitoring quality System mgt. Satisfaction Information Complaints
  • 18. HOSPITAL QUALITY SYSTEM QYALITY SYSTEM INTERNAL EXTENAL QUALITY SYSTEM QUALITY SYSTEM ORG STRUCTURE HOSPITAL ACREDITATION SAFETY, EFFECTIVENESS, ISO CERTIFICATION EFFICIENCY, TIMELINESS, EXTERNAL MEDICAL PATIENT-FUCUSED EQUITY AUDIT
  • 19. COMPONENTS OF INTERNAL QUALITY SYSTE OUTCOMES STRUCTURE PROCESSES OF CARE INPUTS STEPS OUTPUTS •Patients •Inventory Methods •Physiologic •Equipment •Coordination parameters •Supplies •Physician orders •Functional status •Training •Nursing Care •Environment •Ancillary staff OUT COME •Housekeeping •Transport • Patient Satisfaction •Cost
  • 20. INPUT---PROCESS----OUTPUT A. INPUT Input is what we invest inputs are the various needs and resources that projects can draw upon as it sets out to accomplish its work. Inputs include resources like manpower, data, and money and materials. B. PROCESS Process is the ensemble of activities of planning , implementing and monitoring the performance of an activity. Process manipulates the inputs to get the output. It include functions, actions, and operations. Process management is the application of knowledge, skills, tools, techniques , and systems to define, visualize, measure, control, report and improve processes with the goal to meet customer requirements. C. OUTPUT Outputs, are the results of processes, which include products, information, and reports. It disseminate (output) data and information and provide a feedback mechanism to meet an objective. Outputs are the results of processes.
  • 21. D. OUTCOME •It is the Impact of a process. •It may be a level of performance, or achievement. •It may be associated with the process, or the output. Outcomes imply quantification of performance. Outcomes imply quantification of performance. It may include cost reduction , Product appreciation or client satisfaction. The out come may be:- Short Term (learning: awareness, knowledge, skills, motivations) Medium Term (action: behavior, practice, decisions, policies) Long Term (consequences: social, economic, environmental etc.)
  • 22. INTERNAL QUALITY SYSTEM IN PUT PROCESS OUTPUT i). QUALITY i). PERSONNEL i). SOP Error of ii) MATERIAL ii). INTER treatment./Death iii) SUPPLIES PERSONAL Complication iv). FINANCE v). TECHNOLOGY RELATION LAMA, AVLS vi). RULES AND iii). ART OF CARE ii). QUANTITY REGULATIONS iv). MANAGEMENT BTR, BOR, OT TECHNIQUES Disability v).DOCUMENTATION iii). COST iv). CONSUMER SATISFACTION INPUT PROCESS OUT PUT CONTROL CONTROL CONTROL
  • 23. COMPONENTS OF QUALITY SYSTEM 1. INPUTS •Adequate buildings and working space •Necessary equipments always available and functioning •Necessary medications and medical supplies always available •personnel •Anybody who touches the patient or a relevant process in the system:- Departments, physicians, clerks, pharmacy, nursing, OT, ICU, care technicians, phlebotomist, patient transport, administration 2. PROCESSES •All those affecting relevant aspects of patient care:- Clinical decision making, order writing, admission intake, medication delivery, direct patient care, discharge planning, communication, discharge follow-up, etc 3. 4. OUTPUT •Which are the end result of the process :- Physiologic parameters, (Meeting standards ) functional status, (Efficiency, Effectiveness, Quality) 5. OUTCOME Which are the end result of the output Patient satisfaction ,Cost
  • 24. QUALITY SYSTEM Quality does not happen by chance Quality needs to be systematically developed With objective planning, staff involvement and considering patient need.
  • 25. DEVELOPING A QUALITY SYSTEM Quality system Quality Manual Quality procedures Quality plan Quality audit
  • 26. QUALITY SYSTEM STAGE 1 – Chief executive of the firm should commit to quality assurance by declaring quality policy e.g. „Towards total customer satisfaction‟ Make formal statement of the objectives e.g. „ To achieve ISO 9002 certification in 18 months‟ Organizing management structure and defining responsibilities following the above activities STAGE 2 – Examine and review the existing internal documentation, activities and procedures prior to preparation of quality manual and quality procedures i.e. quality system STAGE 3 – Apply general quality procedures to specific contracts when the quality system is completed and fully approved internally. Staff should be familiar with quality assurance and understand their roles but training is required.
  • 27. QUALITY SYSTEM STAGE 4 – Prepare quality plans and additional quality procedures for specific contracts. STAGE 5 – Apply quality plans to specific contracts. Training may be necessary. STAGE 6 – Internal and external audit of quality system; review periodically all quality manuals and procedures.
  • 28. QUALITY MANAGEMENT It is a holistic approach to the art of managing quality output considering together the people, process and products rather than independent factors and driven towards the objective with effective & efficient performance output.
  • 29. ELEMENTS OF QUALITY MANAGEMENT Errors in the hospital are invariably due to system failure in85% of cases(Edward Deming). Only 15% are attributed to people‟s performance. Therefore attention should be given on bad system than bad people. Improvement of systemic errors can be done by:- Commitment of TOP Management, Active support of Middle Management. Education and training of staff. Formation of quality management team. Developing Quality culture in the work place. Making aware all staff about the goal and objective of the organisation. Developing quality policy and quality manual. Developing Standard Operating Procedure for all areas (SOP) . Good Hospital Information System (HIS). Formulation of criterias and Standards for Measuring activities. Constant monitoring and Supervision and feed back. Introducing Medical Audit System. Rectification of errors and Evaluation. External quality control.
  • 30. COMPONENTS OF QUALITY MANAGEMENT SYSTEM QUALITY QUALITY PLANNING CONTROL SYSTEM PATIENT NEED QUALITY SATISFACTION QUALITY IMPROVEMENT ASSURANCE TOTAL QUALITY MANAGEMENT
  • 31. COMPONENTS OF QUALITY PLANNING POLICY STATEMENT RISKS AND ON QUALITY RISK MANAGEMENT PLANNING RECORDS AND DOCUMENTATION QUALITY MANUAL WORK INSTRUCTION OR WORK SHEET SOP
  • 32. 4 TIER QMS DOCUMENTATION QUALITY MANUAL TIER-1 (objectives, policies, philosophies) PROCEDURES MANUAL TIER-2 (purpose, scope, standard) JOB INSTRUCTIONS TIER-3 (work sheet/specific work instructions) TIER-4 FORMS & RECORDS
  • 33. QUALITY MANUAL CONTENTS AIMS AND STANDARDS LEVEL OF MANAGEMENT OBJECTIVES AND CRITERIA SYSTEM CONTROL CORECTION JOB AND DESCRIPTION EVALUATION QUALITY MANUAL MONITORING DEVELOPING AND HIS SUPERVISION QUALITY QUALITY ORGN. TRAINING MEASUREMENTS DIMENTIONS ANALYSIS
  • 34. 1.ORGANISATIONAL ANALYSIS Organisation structure must meet the organisational functions and Objectives. Review organisational relationship with its external environment. Analyse organisational structure with respect to Hierarchy, span of control , Authority and delegation. Functions, Work distributions and accountability. Identify Problem areas, analyse to understand the „Cause and Effect‟ for suitable remedial measures. 2. TRAINING Train the management about quality System. Train the Quality monitoring team. Training of staff how to maintain quality at work place and their specific roll. 3. DEVELOP HIS i) Hospital operation Statistics. - Hospital Resources and their utilization. - Administrative and financial data. ii). Hospital Morbidity Statistics. - Patient characteristics - AVLS, BTR, BOR, Infection rates. - Consultations, complications and Errors. - Type of treatment, investigations. - Outcome of hospital stay, Events, Death/ Discharge.
  • 35. FORMULATION OF CRITERIA AND STANDARDS INDICATRES AREAS Prevention Ambulatory care sensitive Quality Indicators Conditions, House keeping, HIC. BMW disposal. Inpatient Quality Mortality following Indicators ( PROCESS) procedures Mortality for medical conditions Utilization of procedures Volume of procedures Patient Safety Post-operative Indicators complications Iatrogenic conditions/Errors.
  • 36. SERVICE QUALITY MEASUREMENT STRUCTURE PROCESS OUT COME i). QUALITY OF CARE i). STRUCTURE i). PHYSICIAN AND ERRORS DESIGN PATIENT INFECTIONS ii). RESOURCES INTERACTION DEATHS -BEDS ii). INTER- ii). QUANTITY OF -PERSONNEL PERSONAL CARE -- SUPLIES RELATION No. OF PATIENTS -- Finance TREATED iii). TECHNIQUES NO. OF OPERATION -- EQUIPMENTS AND NUMBER OF PATIENT -- SPACE PROCEDURES REFUSED ADMISSION iii). TECHNOLOGY iv). TOTAL QUALITY Iii). COST OF CARE iv). RULES MANAGEMENT COST PER BED v). PROCEDURES (TQM) COST PER PATIENT iv). PATIENT SATISFACTION
  • 37. TYPICAL QUALITY RECORDS QS Elements ISO 9001 Quality Records ref: Mgt responsibility 4.1 Mins. of mgt review Quality system 4.2 QM,PM, PQP,JI/SWI Contract review 4.3 Mins. of tender review Design control 4.4 Design plan, inputs,… Doc & data control 4.5 Register-files, sigs,revs Purchasing 4.6 Register of acceptable subs Control of Cost 4.7 Cost verification records
  • 38. QS Elements ISO 9001 ref: Quality Records Ident & Traceable 4.8 Product/batch records Process control 4.9 MS, stds, qualifications Inspection & Testing 4.10 ITP, insp reports Control of insp, 4.11 Register of equipments and measuring & test cal. certificates equip Insp. & Test status 4.12 Job cards, progress insp rep. Control of complains 4.13 Com reports, defects reports Corrective & Prev A 4.14 Corrective action reports
  • 39. QS Elements ISO 9001 ref: Quality Records Hdlg, storage, 4.15 Delivery notes, dispatch packaging, presv, del advices Control of quality 4.16 Insp./test reports, audits records reports Internal quality audits 4.17 Audit reports, CAR Training 4.18 Qualification records, training course records Servicing 4.19 Visit reports, maint. Logs, Stats. techniques 4.20 Control charts
  • 40. QUALITY CONTROL •QC is product oriented Activity •Quality Control (QC) is a system of routine technical evaluation, to measure and control the quality of the product as it is being developed. •A set of activities designed to evaluate a finished work product/service. •QC activities focus on finding defects in specific out puts - e.g., are the defined requirements the right requirements have been met. •QC is set of activities whose purpose is to ensure that all quality requirements are being met that is defect detection, and done by testing •Quality Control is mainly an inspection function. •QC is product/output Oriented Activity •It is a processes and methods used to compare product quality to requirements and applicable standard •Action taken when a non conformance is detected
  • 41. QUALITY CONTROL Evaluation of planned or systemic actions to provide enough confidence that a product or service has satisfied the given requirements of quality as pre- determined. IDENTIFY THE SERVICE/ PRODUCT MATCH INDICATORS COMPARE WITH ESTABLISH STANDARD EVALUATE OUTPUT QUALITY ACHIEVED QUALITY NOT ACHIVED REVIEW THE PROCESS & ENHANCE STANDARD AREAS OF IMPROVEMENT
  • 42. QUALITY ASSURANCE •QA is process oriented Activity •It is a planned system of monitoring procedures of process conducted by personnel not directly involved in the inventory compilation/development process. •A set of activities designed to ensure that the development and/or maintenance process is adequate to ensure a system will meet its objectives. •QA activities ensure that the process is defined and appropriate. Methodology and standards development are examples of QA activities. •A QA review would focus on the process elements of a project - e.g., are requirements being defined at the proper level of detail. •QA is set of activities whose purpose is to demonstrate that an entity meets all quality requirements. •This is done by adopting a standard set of process and usual QA techniques like review, training, facilitation etc. •It can be termed as defect prevention. •Quality assurance is an audit function.
  • 43. QUALITY ASSURANCE •A set of activities designed to ensure that the development and/or maintenance process is adequate to ensure a system will meet its objectives. INPUT PROCESS OUTPUT IDENTIFY THE PUT THE SYSTEM MONITOR THE OUTPUT PROCESS INTO ACTION AND STANDARD AND SET THE PROTOCOL MONITOR AS PER COMPARE TO SOPs SET QUALITY LEVEL PREPARE SOP SET QUALITY LEVEL
  • 44. QUALITY CONTROL vs. ASSURANCE QUALITY CONTROL QUALITY ASSURANCE • • QC is product oriented Activity QA is process oriented Activity • A set of activities designed to ensure • A set of activities designed to evaluate that the development and/or a developed work product. maintenance process is adequate to • QC activities focus on finding defects ensure a system will meet its in specific deliverables - e.g., are the objectives defined requirements the right • It ensure that the process is defined requirements and appropriate. Methodology and • After manufacturing the product, the standards development are examples quality control process begins. of QA activities. • quality control follows the guidelines • It focus on the process elements of a and standards established by project - e.g., are requirements being assurance of quality department to defined at the proper level of detail. check whether output meet the quality • is meant to produce defect-free goods requirements or not. or services which means being right • Depending upon the results, suitable the first time with no or minimum corrective action is taken by quality rework. control personals.
  • 45. QUALITY CONTROL vs ASSURANCE QUALITY CONTROL QUALITY ASSURANCE • Quality control ensures that these • quality assurance process is a series of defined standards are followed at steps taken at the different stages of the every step. product life cycle i.e. from the product concept to the launch of the product to its • It is focused on detecting the defects obsolescence. once the product is manufactured. • Assurance of quality is a set of preventive • Quality control is a failure detection activities, which are focused on processes system that uses a testing technique • Assurance defines the standards to be to identify errors or flaws in products followed • some process parameters cannot be • Quality guarantee department develops all the planning processes and procedures to controlled and here is where quality make sure that the output is of good quality control comes into picture. • Assurance of quality is a failure prevention • Quality control is a corrective process system that predicts safety, quality • The processes of quality control standards and legality involve calibration, sampling and • Quality guarantee processes involve documenting reviews and giving implementing real-time quality checks in feedback for improvement every department • It is a monitoring process • It is an Evaluation process
  • 46. QUALITY IMPROVEMENT Maintaining the process of quality standards through out and efforts made to improve upon is termed as „continuous quality improvement‟. Continuous quality improvement is therefore a key component of successful management technique. There are four “quality improvement initiatives” that hospitals could use as a yardstick to achieve the best outcomes:-  Nurses must be actively involved throughout the process,  Quality outcomes should be transparent,  Decisions must be supported by quality research,  Staff should feel empowered to make decisions and be held accountable
  • 47. QUALITY IMPROVEMENT PLAN The quality improvement plan emphasizes on three aspects for continuous improvement SYSTEM SERVICE/PRODUCT PEOPLE‟S IMPROVEMENT IMPROVEMENT 1. Quality of supplies 2. Sterile procedure 1. Motivation & leadership 3. Working Environment PROCESS 2. In service training & skill 4. Proper maintenance of IMPROVEMENT developments. records 3. Awards & recognition 5. SOPs 4. Seminar & work shops Inpatient Quality 6. Use of latest technique for 5. Empowerment of people Indicators (IQIs) separation Prevention Quality Indicators (PQIs) Patient Safety Indicators (PSIs)
  • 48. COMPONENTS OF IMPROVEMENT A. SERVICE IMPROVEMENT  Can be done through introducing latest technology and machines  Ensuring supplies at right time at right place in right quantity.  Regular maintenance and standardisation of equipments.  Implementing standard operating procedure. B. PROCESS IMPROVEMENT  Introducing suitable modern management techniques  Follow ISO certification guide lines  Get the certification from NABH  Define clear cut job responsibilities.  Fix accountability.  Detect problems early and solve it. C . PEOPLES IMPROVEMENT  Develop regular staff training program  Onsite training of staff at work place.  Develop staff work culture  Introduce quality circle discussions.  Inculcate team spirit, leadership and motivation among workers.
  • 49. TOTAL QUALITY MANAGEMENT T – Take the entire organization, patient, staff and its activities into consideration. Q – Quantum output to meet pre- determined standard/ objective. M – Manage step by step i.e. Planning, Organizing, Controlling, Provisioning, Staffing.
  • 50. •Determine goals & priorities .Apply the plan •Determine processes •Train & educate the workers •determine tracking indicators •Monitor tracking indicators •Take action to eliminate any problems •Standardize process if successful •Check results of •If not Plan future improvements implemented plan •Identify any problems TQM CYCLE
  • 51. WHAT IS TOTAL QUALITY MANAGEMENT Total Quality Management is that aspect of the overall management function that determines and implements the quality policy. 1. It is a business management strategy aimed at embedding awareness of quality in the entire organizational process. 2. It is defined as a combination of organization functions and management techniques centered on quality, based on the participation of all members focusing on long term success through meeting customer needs, satisfaction and organizational objective. 3. Quality management takes in to consideration PEOPLE, PROCESS and PRODUCT When along with these three elements Patients need is also taken into consideration It is termed as „TOTAL QUALITY MANAGEMENT‟ OBJECTIVE: Do the right things, right the first time, every time and reduce losses due to wasteful practices.
  • 52. FOUR “Ps” OF TQM Peoples Process Commitment Improvement TQM Patients Need Product Satisfaction In time
  • 53. PRINCIPLES OF TQM C – Commitment by top management O – Organization and structure for TQM N - Normal financial control activities S – Supplier relationships initiative T – Training, education and safety awareness of staff R – Relationships cordial with customers U – understanding and commitment by employees C – Communications net working T – Teamwork encouragement I – Independent certification level to ISO 9000 O – Objective measurement of functions N – Natural use of tools and techniques and skills
  • 54. SUCCESS OF TOTAL QUALITY MANAGEMENT TQM MANAGEMENT AND CULTURE EMPLOYEE STAFF COMMITMENT EMPOWERMENT LEADERSHIP AT TQM QUICK TOP SUCCESS RESPONSE FACT BASED CUSTOMER DECISION FOCUS MAKING CONTINOUS IMPROVEMENT
  • 55. DEVELOPING TQM CULTURE All departments of the hospital were asked to compile a list of quality problems Review of the list by the Hospital Quality Committee Provide feedback to the departments and support departments for the analysis of problems and design of solutions HOSPITAL QUALITY COMMITTEE Establish a Comprehensive quality plan for the Hospital in close cooperation with departments Initiate, coordinate and support Quality Groups in the various hospital departments To give advice to Quality Groups for developing their action plans Support implementation of action plans of the Quality Groups Motivation and appraisal of Quality Groups Feedback to Hospital Management Team Establish quality circles in all departments Train more staff with QM skills Work on the problems with each department
  • 56. QUALITY CIRCLES(QC) • SIGNIFICANCE OF QC: I. UTILISING EDUCATION,EXPERIENCE AND CREATIVITY. • QC –AN INTEGRATED PROGRAMME: 1. MEMBERS 2. CIRCLE LEADERS 3. FACILITATORS 4. CO-ORDINATOR 5. STEERING COMMITTEE • PROCESS a) PROBLEM IDENTIFICATION b) PROBLEM SELECTION c) PROBLEM ANALYSIS d) IMPLEMENTATION &RECOMMENDATION TO THE MANAGEMENT. QC ENVISAGES PARTICIPATORY MANAGEMENT STYLE WITH A “BOTTOM UP” APPROACH.
  • 57. TQM - CULTURE COMMITMENT TO MANAGEMENT OF REDUCE MEETING EMPLOYEES PROCESSING COUSTOMER TIME AND COST NEED FINISH IN SET PREDETERMINE NEW TARGET TIME TQM ACTIVITIES CUSTOMER RECOGNITION SATISFACTION & AWARD IMPROVE IMPROVE EMPLOYEES EMPOWERMENT PLAN SYSTEM
  • 58. QUALITY MANAGEMENT vs. TQM Quality element Previous state (Traditional) Total Quality Management Definition Product oriented Customer oriented Priorities Second to service and Cost First among the equals of service and cost Decisions Short term Long term Source: Basterfieldet al, 2002 pp3) Emphasis Detection Prevention Errors Operations System Responsibility Quality Control Every one Problem solving Managers Teams Procurement Price Life cycle costs, partnership Manager‟s Role Plan, assign, control and Delegate, coach, facilitate and enforce mentor
  • 59. • Inadequate financing • Inadequate M3 • An expenditure and not • Large gap between demand & investment supply • No regionalisation of Med • Lack of motivation, misuse & care policy pilferage. • No strict referral system • Poor budgetary planning • Political and beaurocrate •Unionism internal conflicts interference • Lack of latest gadgets • Lack of regular re-orientation • Poor handling Of • training in advancement of grievances/complaints technology • Lack of standing guidelines/procedures • evaluation of care from patient/relatives DR.N.C.DAS
  • 60. QUALITY DIAMOND (FOUR ELEMENTS OF QUALITY SERVICE) CUSTOMER SATISFACTION CONTINUITY COMMITMENT IN IMPROVEMENT OF STAFF QUALITY DIAMOND EXPECTATION OF PATIENT AND STAFF
  • 61. hospiad Hospital Administration Made Easy http//hospiad.blogspot.com An effort solely to help students and aspirants in their attempt to become a successful Hospital Administrator. DR. N. C. DAS