Tqm Program Implementation Steps

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TQM PROGRAM

IMPLEMENTATION STEPS


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RECAP

PERFORMANCE IMPROVEMENT

PERFORMANCE PROCESS (POSITIVE

DISCIPLINE)

PERFORMANCE APPRAISAL PROCESS

SITUATIONAL ACTIVITIES/IDENTIFYING

MISMANAGEMENT IN THE AREA


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Total Quality Management

Is an integral system of principles, methods, andbest practices that provide a framework fororganizations to strive for excellence ineverything they do.

TQM: is a collection of principles, techniques,processes, and best practices that over time havebeen proven effective

Most of all world-class organization exhibit the

majority of behaviors with TQM (according toDecker, Juran, Deming, Ishikawa, Crosby,Feigenhaven).


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STEPS IN TQM:

1. CUSTOMER FOCUS

2. PLANNING PROCESS

3. PROCESS MANAGEMENT4. PROCESS IMPROVEMENT

5. TOTAL PARTICIPATION


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CUSTOMER FOCUS

TQM is a customer-based vision of companymanagement to increase the value of goods and

services offered to customers.

Companies will collect and review customer data

regarding satisfaction on goods and services,current demands for new products and suggested

changes for existing products.

Developing a customer-focused strategy of

improving products and meeting customer needs

helps companies achieve high TQM process.


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PLANNING PROCESS

Using the information gathered from theircustomer-focused strategy, companies will plan their

business processes to meet the desires of customers.

Changing production materials, correcting product

flaws and creating new product features are part of

the planning process of TQM.

Businesses must understand that product quality is

based on the perception of customers; planning anddeciding how to achieve this perception are

important in TQM.


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PROCESS MANAGEMENT

Once the planning process is complete, managementcan focus on the actual production process of TQM.

Process management includes reviewing products and

services to ensure they are consistent in quality

standards, to ensure products continue to meetcustomer needs, and to ensure products are available in

all markets.

Managers must also review the cost of raw materials and

production methods, ensuring that delivering high-quality goods can be done at relatively cheap costs.


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PROCESS IMPROVEMENT TQM is driven by the understanding that no

consumer market continues to operate at the samelevel of demand every year.

As the business cycle moves through booms and

busts, customers change preference and incomeschange; companies must be willing to adjust to thesechanges to ensure TQM for their products andservices.

Improving processes to reduce costs, findingcheaper raw materials or reducing labor costs areways businesses may improve processes to remaincompetitive.


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6. LEADERSHIP IS SUBSTITUTED FOR SLOGANS ANDEXHORTATIONS

7. LONG-TERM EMPHASIS ON MEASURABLEPROCESSES AND PRODUCTIVITY IMPROVEMENT

8. UNDERSTAND THE CURRENT PROCESS BEFOREIMPROVEMENT BEGINS

9. CROSS- FUNCTIONAL ORIENTATION ANDTEAMWORK

10. EFFECTIVE USE OF STATISTICAL METHODS ANDQUALITY CONTROL TOOLS

PRINCIPLES OF TQM

IMPLEMENTATION


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PRINCIPLES OF TQM

IMPLEMENTATION

11.CONSTANT PROCESS, PRODUCT, AND SERVISE

IMPROVEMENT

12.INCENTIVIZE TQM INVOLVEMENT

13.INFORMATION SHARING

14.ELIMINATE COMMUNICATION BARRIERS

15.SUPPLIERS MUST HAVE A TQM PHILOSOPHY


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TQM

TQM is a management philosophy that seeks

to integrate all organizational functions

(marketing, finance, design, engineering, and

production, customer service, etc.) to focuson meeting customer needs and

organizational objectives.


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TQM INNURSING HEALTH CARE


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TQM IN NURSING HEALTH CARE

Qualityrefers to excellence of a product or a

service, including its attractiveness, lack of

defects, reliability, and long-term durability.

Quality assuranceprovides the mechanisms to

effectively monitor patient care provided by

health care professionals using cost-effective

resources.


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Nursing programmes of quality assurance: areconcerned with the quantitative assessment ofnursing care as measured by proven standards ofnursing practice.

Quality assurance system motivates nurses tostrive for excellence in delivering quality care and

to be more open and flexible in experimentingwith innovative ways to change outmodedsystems.

Florence Nightingale introduced the concept of

quality in nursing care in 1855 while attendingthe soldiers in the hospital during the Crimeanwar.


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CONCEPTS OF QUALITY IN HEALTH

CARE

Quality is defined as the extent of

resemblance between the purpose of

healthcare and the truly granted care

(Donabedian 1986).

Quality assurance originated in

manufacturing industry to ensure that the

product consistently achieved customersatisfaction.


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Quality assurance as the monitoring of the

activities of client care to determine thedegree of excellence attained to the

implementation of the activities. (Bull,

1985) Quality assurance is the defining of nursing

practice through well written nursing

standards and the use of those standards as a

basis for evaluation on improvement of client

care (Maker 1998).


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CREDENTIALING

formal recognition of professional ortechnical competence and attainment ofminimum standards by a person or agency

Credentialing process has four functional

componentsa) To produce a quality product

b) To confer a unique identity

c) To protect provider and publicd) To control the profession.


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LICENSURE

Individual licensure is a contract between theprofession and the state, in which the professionis granted control over entry into and exists fromthe profession and over quality of professional

practice. The licensing process requires that regulations be

written to define the scopes and limits of theprofessionals practice.

Licensure of nurses has been mandatedthroughout the world by laws and regulations..


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CERTIFICATION

Certification is usually a voluntary processwith in the profession.

A persons educational achievements,

experience and performance on examinationare used to determine the persons

qualifications for functioning in an identified

specialty area.


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ACCREDITATION

An organization empowered to lay downstandards in nursing and medical care as toregulate the quality of care.

ISO (INTERNATIONAL STANDARD

ORGANIZATION)

JCI

NABH

Accreditation Canada

NAAC


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B. SPECIFIC APPROACH (QUALITY

ASSURANCE PROGRAMME)

1. PEER VIEW

2. STANDARD AS DEVICE FOR QUALITY

ASSURANCE3. AUDIT AS A TOOL FOR QUALITY

ASSURANCE/NURSING AUDIT


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SPECIFIC APPROACH

A. PEER VIEW:

Peer review is divided in to two types.

1. The recipients of health services by means of

auditing the quality of services rendered.2. The health professionalevaluating the quality of

individual performance.


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ANA STANDARDS

Standard 3: The plan of nursing care includesgoals derived from the nursing diagnoses.

Standard 4: The plan of nursing care includes

priorities and the prescribed nursingapproaches or measures to achieve the goalsderived from the nursing diagnoses.

Standard 5: Nursing actions provide forpatient participation in health promotion,maintenance, and restoration.


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ANA STANDARDS

Standard 6: Nursing actions assist the patient to

maximize his health capabilities.

Standard 7: The patients progress or lack of

progress towards goal achievement is determinedby the patient and the nurse.

Standard 8: The patients progress or lack of

progress towards goal achievement directs re-assessment, re-ordering of priorities, new goal

setting, and a revision of the plan of nursing care.


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SPECIFIC APPROACH

C. AUDIT AS A TOOL FOR QA:Nursing auditmay be defined as a detailed

review and evaluation of selected clinical

records in order to evaluate the quality ofnursing care and performance by comparing it

with accepted standards.

An audit means the examination or review ofrecords.


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Nursing Audit

A Retrospective Audit: is the evaluation of aclients record after discharge from an agency.

A Concurrent Audit: is the evaluation of a

clients health care, while the client is stillreceiving care from the agency.

These evaluation use interview, direct

observation of nursing care, and review ofclinical records to determine whether specific

evaluation criteria have been met.


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Nursing AuditPeer Review: another type of evaluation of care

In the peer review, nurses functioning in thesame capacity, that other equally qualifiednurses.

The peer review is based on pre-establishedstandards or criteria.

There are 2 Types of Peer Review:

Individual Nursing Audits


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Individual peer review: focuses on the

performance of an individual nurse. Nursing Audit peer review: focuses on

evaluating nursing care through the review of

records. The success of these audits depends on

accurate documentation, auditors assume

that if the data have not been recorded, thecare has not been given.


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HEALTHY BREAK


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QUALITY ASSURANCE PROCESS

Establishment of standards or criteria

Identify the information relevant to criteria Determine ways to collect information

Collect and analyze the information

Compare collected information with establishedcriteria

Make a judgment about quality

Provide information and if necessary, take

corrective action regarding findings ofappropriate sources

Determine ways to collect the information

FACTORS AFFECTING QUALITY


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FACTORS AFFECTING QUALITY

ASSURANCE IN NURSING CARE

1) Lack of Resources

Insufficient resources, infrastructures, equipment,

consumables, money for recurring expenses and

staff make it possible for output of a certainquality to be turned out under the prevailing

circumstances.

2) Personnel problems Lack of trained, skilled and motivated employees,

staff indiscipline affects the quality of care.


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3) Improper maintenance

Buildings and equipments require proper

maintenance for efficient use. If not maintainedproperly the equipments cannot be used in givingnursing care.

To minimize equipment down time it is necessary

to ensure adequate after sale service and servicemanuals.

4) Unreasonable Patients and Attendants

Illness, anxiety, absence of immediate response to

treatment, unreasonable and unco-operativeattitude that in turn affects the quality of care innursing.


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5) Absence of well informed population

To improve quality of nursing care, it is

necessary that the people become

knowledgeable and assert their rights to

quality care.

This can be achieved through continuouseducational program.


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7) Lack of incident review procedures

During a patients hospitalizations reveal incidents

may occur which have a bearing on the treatmentand the patients final recovery. These criticalincidents may be:

a) Delayed attendance by nurses, surgeon,physician

b) Incorrect medication

c) Burns arising out of faulty procedures

d) Death in a corridor with no nurse / physicianaccompanying the patient etc.


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8) Lack of good and hospital information

system

A good management information system is

essential for the appraisal of quality of care.

a) Workload, admissions, procedures and

length of stay

b) Activity audit and scheduling of procedures.


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9) Absence of patient satisfaction surveys

Ascertainment of patient satisfaction at fixed

points on an ongoing basis. Such surveys

carried out through questionnaires, interviews

to by social worker, consultant groups, and

help to document patient satisfaction withrespect to variables that are

a) Delay in attendance by nurses and doctors.

b) Incidents of incorrect treatment


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10) Lack of nursing care records

Nursing care records are perhaps the most

useful source of information on quality of care

rendered. The records.

a) Detail the patient condition

b) Document all significant interaction

between patient and the nursing personnel.

c) Contain information regarding response totreatment

d) Have the dates in an easily accessible form.


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11) Miscellaneous factors

a. Lack of good supervision

b. Absence of knowledge about philosophy ofnursing care

c. Lack of policy and administrative manuals.

d. Substandard education and training e. Lack of evaluation technique

f. Lack of written job description and jobspecifications

g. Lack of in-service and continuing educationalprogram

STAGES OF THE DEVELOPMENT OF


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STAGES OF THE DEVELOPMENT OF

INTERNATIONAL STANDARDS

(ACCREDITATION)

An International Standard is the result of an

agreement between the member bodies of

ISO. It may be used as such, or may be

implemented through incorporation in

national standards of different countries.

International Standards are developed


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International Standards are developed

by ISO technical committees (TC) and

subcommittees (SC) by a six-stepprocess:

Stage 1: Proposal stage

Stage 2: Preparatory stage

Stage 3: Committee stage

Stage 4: Enquiry stage

Stage 5: Approval stage

Stage 6: Publication stage


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STAGE 1: PROPOSAL STAGE

The first step in the development of an InternationalStandard is to confirm that a particular InternationalStandard is needed. A new work item proposal (NP) issubmitted for vote by the members of the relevant TCor SC to determine the inclusion of the work item in theprogramme of work.

The proposal is accepted if a majority of the P-members of the TC/SC votes in favour and if at leastfive P-members declare their commitment to

participate actively in the project. At this stage aproject leader responsible for the work item is normallyappointed.


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STAGE 2: PREPARATORY STAGE

Usually, a working group of experts, the chairman

(convener) of which is the project leader, is set up

by the TC/SC for the preparation of a working

draft. Successive working drafts may beconsidered until the working group is satisfied

that it has developed the best technical solution

to the problem being addressed. At this stage, the

draft is forwarded to the working group's parent

committee for the consensus-building phase


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STAGE 3: COMMITTEE STAGE

As soon as a first committee draft is available,

it is registered by the ISO Central Secretariat. It

is distributed for comment and, if required,

voting, by the P-members of the TC/SC.Successive committee drafts may be

considered until consensus is reached on the

technical content. Once consensus has beenattained, the text is finalized for submission as

a draft International Standard (DIS).


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STAGE 4: ENQUIRY STAGE

The draft International Standard (DIS) is circulated toall ISO member bodies by the ISO Central Secretariatfor voting and comment within a period of five months.It is approved for submission as a final draft

International Standard (FDIS) if a two-thirds majority ofthe P-members of the TC/SC are in favour and not morethan one-quarter of the total number of votes cast arenegative. If the approval criteria are not met, the text is

returned to the originating TC/SC for further study anda revised document will again be circulated for votingand comment as a draft International Standard.


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STAGE 5: APPROVAL STAGE

The final draft International Standard (FDIS) is circulated toall ISO member bodies by the ISO Central Secretariat for a

final Yes/No vote within a period of two months. If technicalcomments are received during this period, they are nolonger considered at this stage, but registered for

consideration during a future revision of the InternationalStandard. The text is approved as an International Standardif a two-thirds majority of the P-members of the TC/SC is in

favour and not more than one-quarter of the total numberof votes cast are negative. If these approval criteria are not

met, the standard is referred back to the originating TC/SCfor reconsideration in light of the technical reasonssubmitted in support of the negative votes received.


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STAGE 6: PUBLICATION STAGE

Once a final draft International Standard has

been approved, only minor editorial changes,

if and where necessary, are introduced into

the final text. The final text is sent to the ISOCentral Secretariat which publishes the

International Standard.

IMPACT OF ISO IN A LOCAL HOSPITAL


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IMPACT OF ISO IN A LOCAL HOSPITAL: Positive impacts:

Nurses are accountable for their actions and, professionally, we

have responsibility to evaluate the effectiveness of our care Nurses can deliver a high standard of care, and being empowered to

identify and resolve problems can add to personal satisfaction withwork

Documents state clearly how the health service should perform and

what the patient can expect Guaranteeing standards of care to the public must be a duty of all

those who work within the health service

Nurses are actively involve in audit, service reviews, standard-setting and customer relations

Improves the overall quality of nursing care

Improves all types of documentation and communication

Helps in professional growth


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Negative impacts:

Lack of adequate resources

Lack of trained, skilled and motivated employees, staffindiscipline affects the quality of care.

ISO activities may overburden the nursing personnel

Nurses will not get adequate time to spent with thepatient, most of the time may be spending forrecording and reporting

The hospital will be restricted only to ISO standards

Hospital has to provide special training for all the staffsthose who are involved in ISO inspection

All types of services will be under the control of ISO


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Negative impacts:

Gives more importance to documentation

Over-burden for the teachers

Teachers need to take special training in

maintaining the standards

Not observing the actual practice

Organizational philosophy and policies has to

be modified according to the ISO standards


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CONCLUSION

To ensure quality nursing care within the contemporaryhealth care system, mechanisms for monitoring and

evaluating care are under scrutiny. As the level of knowledge increases for a profession, the

demand for accountability for its services likewise increases.

Individuals within the profession must assume responsibilityfor their professional actions and be answerable to the

recipients for their care. As profession become more interdependent, it appears that

the power base will become more balanced, allowingindividual practitioners to demonstrate their competenceand expertise.

Quality assurance programme will helps to improve thequality of nursing care and professional development.


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