Much has been researched and recorded about Continuous Improvement (CQI) and TQM in manufacturing industry; however, less focus has been paid to the healthcare sector hence little efforts in the application of these quality approaches. This has led to poor services in a number of hospitals and a lack of confidence from the customers and patients. This, in other words, relates customers’ satisfaction directly hence the need to be addressed.
Overview of TQM and Continuous improvement
Australian Council on Healthcare Standard was formed in 1976 with the aim of quality management as the main motive (Agarwal, Green, Agarwal & Randhawa, 2016). However, this council has not been able to probe the quality module of the hospital’s services to the maximum. Low-quality services are still experienced to date especially in the rural amenities (Dawson, Stasa, Roche, Homer & Duffield, 2014). Regarding the recent survey done in New South Wales hospitals, only 57 out of the total 92 hospitals surveyed have clear TQM and CQI systems. This is a calling alarm in this sector of the economy.
Quality in healthcare over the decades is viewed by practitioners, patients, services suppliers, and the general community in diverse views. The customer’s view of quality is reliant on the convenience of the care, how able they received the care, service provider, fastness in service delivery and how gentle the health practitioners were at the time of service delivery. According to Tohamy, Raoush, Doweri& Alkhatib (2015), patients’ views of the quality of health care are grounded in the whole process.
TQM concepts in regard to CQI were developed in the USA in the early 1930s. The Concepts were applied during post-war with Japan (Andrews, Suriadi, and Wynn & Hofstede.2017). Many pieces of research have associated USA success in that war with the adoption. While quality management methods outlined by Abri and Balushi (2014), were initially useful to the engineering sector, there has been a tremendous increase in their applications in the healthcare sectors.
Hospital systems have begun to apply these concepts in Australia over the last few years (Fryer, Antony & Douglas. 2015) This has been motivated by a number of factors such as increased costs of providing health care, poor services in some of the hospitals and the need to respond to the knowledgeable clients who expect more details and contribution in the services offered (Ismail, Khurram & Jafri. 2011)
Health facilities in Australia must meet compliance with the specified accredited procedures. This should be done for both TQM and CQI under the Healthcare Act 1997. Development of measurement and monitoring systems in health facilities in most cases are believed to be straightforward, easy to realize (Healy. 2016). However, hospitals are part of the broad service industry and in this case, they contain many hidden and intangible factors that are involved in the delivery of the health care to the patients.
In most cases, the impact of TQM and CQI in healthcare delivery are viewed by many on the basis of customer perceptions of the services. This view of the quality in most cases is not always clear. According to Kronick et al. (2015), most customers are unable to openly express their opinions on the nature of the services received. This may be associated with the fear of victimization by the authority involved. (Kristensen et al. 2015).
Total Quality Management System in the healthcare
TQM strategies applied in the healthcare organization in Australia as specified by the National Health Strategy involve community participation in two main levels. The first participation is related to the separate decision-making. This recognizes the ways clients can contribute to their personal healthcare (Dawson, Stasa, Roche, Homer & Duffield, 2014). It involves suggestions for improvement of services delivery in the hospitals. The second strategy is the participation by the whole community groups. According to Ooi, Lin, and Tan & Yee. (2011), community participation in TQM in healthcare services is of three categories:
The participation of all stakeholders in the healthcare services system is considered as the main aftermath and pointer of superiority in TQM. Leggat, Bartram, Stanton, Bamber &Sohal. (2015), suggested that changes in organization methods as dictated by the TQM have a key influence on the organization accounting for the function in healthcare. TQM requires new approaches to allow the effects of deteriorating quality to be assessed extensively.
Critical factors that influence TQM in the healthcare sector
TQM adoption and implementation require a transformation in the structure, system, and process in order to achieve improved performance. According to Shah and Rahman 2016, there are seven factors that greatly influence the TQM in the healthcare sector. These are:
|
Factors |
Level of influence (%) |
|
Management obligation |
33 |
|
Staffs involvement |
20 |
|
Consumer satisfaction |
14 |
|
Cooperation and teamwork, |
12 |
|
Processes, |
10 |
|
Continuous enhancement, |
6 |
|
Training and the culture modification |
5 |
Continuous Quality improvement Implementations
Trying to compare the CQI procedure in healthcare and manufacturing sector, Partington, Wynn, Suriadi, Ouyang & Karnon. (2015), recorded that CQI procedures consist of undeviating movements, repetitive stages, standardized inputs, high analyzability, and little employee discretion in manufacturing industries. Nevertheless, health sector CQI procedures include non-standardized and flexible inputs, non-repetitive processes, erratic demand points and high employee discretion
Australian accreditations system for the health system specified four major standards for CQI system. These standards generate more than 40 outcomes. These principles are:
These principles are generally very comprehensive to cover every aspect of service delivery. Each standard has several results that are also comprehensive. They can possibly be applied to the diverse levels of services needs in the whole system. The outcomes are very broad and intangible in most cases. Due to the way many healthcare aftermaths are articulated, it is more suitable to monitor the procedures. This leads to the outcomes rather than just endeavouring to gauge the outcome alone (Alolayyan, Mohd, Idris, & Ibrehem. 2011)
According to Kronick et al. (2015), there are three types of monitoring in relation to CQI in the healthcare.
Talib, Yang & Rajagopalan. (2013), said that the legitimacy is one of the most significant aspects involved in the case of measurement and monitoring procedure. Validity according to him covers two main area:
In most cases, statistical procedure control techniques are applied in the healthcare sector to recognize and analyze the potential, simultaneous and retrospective evaluation of the data in advancing the healthcare services for protective, intervention, and corrective measures. Kristensen et al. (2015) gave suggestions on seven steps for CQM in healthcare:
Limitations and shortcomings
TQM and Continuous improvement implementation in the health care system in Australia faces a number of obstacles and short comes. Previous statistics indicated that the adoption is 1.37% lower than other adoption rates. The implementation relies majorly on the capability of the management to embrace and apply their values and philosophies in the healthcare systems. This is, however, not practised by current management in public hospitals. Ineffective .
TQM and CQI determinations in the healthcare management is ascribed to the departmentalized, inflexible and, classified structure, expert independence. Other factors include uneasiness among executives and hitches encountered in assessing healthcare procedures and outcomes. Hindrances to achievement may also include inconsistence executives and employees’ obligation to the participation of the concepts in the daily activities. Inefficient management and, lack of a qualitative- oriented philosophy, inadequate training, and insufficient resources also play a big role in the pullback. These limitations are expected to continue in the future years if the current trend is something to go by.
According to healthcare incidents metric, hospitals in Australia provided the following data which measure the quality and level of commitments in hospitals:
The metric is very important since it provides data on the quality of health care received by patients. According to this data, it is clear the healthcare sector has to improve on the quality in order to curb those incidents.
According to Kronick et al. (2015), failures in TQM and CQI can be broadly categorized into three main groups.
Key risks and issues
Risks associated with the poor or failure of TQM and CQI implementation in the healthcare system are manifested by the outcomes in some hospitals in Australia. To begin with, according to Ooi, Lin, and Tan & Yee. (2011), the lack of customers and patient satisfaction is one of the risks. A hospital that is not committed to customers’ satisfaction lose the customers to competitors who respond to their demands.
It is only 367 healthcare facilities in Australia that got 5 stars rating on patient pleasure. Conferring to current healthcare assessment of data, a overall of 117 hospitals were rated the lowest position of 1 star; 412 were two stars, 287 got 3 stars; 807 were rated 4 stars, whereas 367 got the uppermost position of 5 stars. This translate into low patients turnout and the negative image of the hospital to the public.
Secondly, the workforce in the hospital become disengaged, leading to a decrease in productivity, and increased attrition in the service delivery. TQM dictates involvement and engagement of the employees in the service delivery process right from the beginning to the end on a continual basis.
Thirdly, lack of a document control and management systems prevent the hospital from delivering professional services, because it lacks formal starting point. TQM specifies the requirements for development, approval, and periodic review of procedures that govern healthcare activities.
What was done well?
Over the last five years, the number of the hospital in Australia that has adopted TQM in conjunction with CQI has increased by an average 13%. This has been associated with a number of factors such as the need to enter the global market. The global market in healthcare delivery dictates that the services be delivered professionally to satisfy all the stakeholders associated with the healthcare facilities (Andrews, Suriadi, Wynn & Hofstede.2017). The hospitals have adopted operational and information technology metrics/scorecards. According to …….., 87% of the hospitals in Australia had adopted these metrics by June 2017. The metrics were targeted to bring equity measures, patient-oriented, effectiveness, timelines and patient safety measures.
In connection with this, the level of confidence from the public to healthcare systems in Australia has increased to 79.3% in the last few years (Kristensen et al. 2015). This has resulted in an increase in the number of patients who visits the local health facilities per day unlike in the past one decade where 4 out of 10 patients visited the healthcare facilities. The number has doubled in the time span of 10 years.
What was not done well
Andrews, Suriadi, Wynn & Hofstede. (2017) suggested that the quality management in the health care system in Australia could have been achieved effectively if the management and the staffs were holistically involved and engaged. Only a few hospitals in Australia have adopted the SERVQUAL Model. This model is used to monitor and evaluates the clinical performances of the practitioners. This model has been proven to improve the quality of health care services and it could have been better if adopted by all hospitals. In many hospitals in the late 1990s to date, the quality management has been left to be the role of management alone. Training was not done to all the staffs in the hospital and most employees misinterpret the concepts of TQM and CQI. This has led to misunderstanding and poor service deliveries in the hospitals
Improvements in Quality management
According to Kronick et al. (2015), Quality management systems and in specific TQM and CQI is not an option but a basic in the quality of service delivery in any healthcare facility. Some hospitals in Australia have adopted the SERVQUAL Model. This model is used to monitor and evaluates the clinical performances of the practitioners. This model identifies opportunities for improvement and also recommend mechanisms for suitable improvements. As aforementioned earlier, this is not a single person or department role but a full organization role. TQM principles should be clear to every stakeholder in the healthcare facility.
The principles should be printed and posted in every office for staffs, customers, and patients to familiarize themselves with its content. Another recommendation is on the frequencies and regularity of monitor procedures. It should be done on a regular basis and improvements should be done as soon as possible when needed. Proper disciplinary measures should be specified for the employees and any person who may intentionally compromise the quality delivery in the hospitals.
Conclusion
In conclusion, the research has tremendously highlighted the importance of the proper quality management systems. It is now evident why the healthcare sector in Australia should adopt and implement the TQM and CQI in the management of the hospitals. TQM and CQI relate directly to customer’s satisfaction hence should be highly regarded. Failure to adopt these concepts as discussed is associated with massive losses and diminishing effects that are directly linked to poor quality services in the hospitals. Quality delivery has been well elaborated and with no doubt if everyone performs what their roles well, quality will be achieved effectively in the hospital systems.
References
Agarwal, R., Green, R., Agarwal, N., & Randhawa, K. (2016). Management practices in Australian healthcare: can NSW public hospitals do better?. Journal of health organization and management, 30(3), 331-353.
Al-Abri, R., & Al-Balushi, A. (2014). Patient satisfaction survey as a tool towards quality improvement. Oman medical journal, 29(1), 3.
Alolayyan, M. N. F., Mohd Ali, K. A., Idris, F., & Ibrehem, A. S. (2011). Advance mathematical model to study and analyse the effects of total quality management (TQM) and operational flexibility on hospital performance. Total Quality Management & Business Excellence, 22(12), 1371-1393.
Andrews, R., Suriadi, S., Wynn, M., & ter Hofstede, A. H. (2017). Healthcare process analysis. In Process Modelling and Management for HealthCare. CRC Press.
Dawson, A. J., Stasa, H., Roche, M. A., Homer, C. S., & Duffield, C. (2014). Nursing churn and turnover in Australian hospitals: nurses perceptions and suggestions for supportive strategies. BMC nursing, 13(1), 11.
El-Tohamy, A. E. M. A., Al Raoush, A. T., Al Doweri, H. F., & Alkhatib, A. J. (2015). IS THE ORGANIZATIONAL LEADERSHIP COMMITTMENT PRINCIPLE THE MOST SIGNIFICANT TQM PRINCIPLE ON HOSPITAL EFFECTIVENESS?. European Scientific Journal, ESJ, 11(10).
Fryer, K. J., Antony, J., & Douglas, A. (2015). Critical Success Factors of Continuous Improvement in the Public Sector: A review of literature and some key findings.
Healy, J. (2016). Improving health care safety and quality: reluctant regulators. Routledge.
Ismail, K., Khurram, W., & Jafri, S. K. A. (2011). Role of leaders’ behavioral integrity in determining successful TQM implementation and organizational performance: A study on public hospitals of Pakistan. International Journal of Humanities and Social Science,1(10), 236-241.
Kristensen, S., Hammer, A., Bartels, P., Suñol, R., Groene, O., Thompson, C. A., … & Wagner, C. (2015). Quality management and perceptions of teamwork and safety climate in European hospitals. International journal for quality in health care, 27(6), 499-506.
Kronick, S. L., Kurz, M. C., Lin, S., Edelson, D. P., Berg, R. A., Billi, J. E., … & Meeks, R. A. (2015). Part 4: systems of care and continuous quality improvement: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 132(18_suppl_2), S397-S413.
Leggat, S. G., Bartram, T., Stanton, P., Bamber, G. J., & Sohal, A. S. (2015). Have process redesign methods, such as Lean, been successful in changing care delivery in hospitals? A systematic review. Public Money & Management, 35(2), 161-168.
Ooi, K. B., Lin, B., Tan, B. I., & Yee-Loong Chong, A. (2011). Are TQM practices supporting customer satisfaction and service quality?. Journal of Services Marketing, 25(6), 410-419.
Partington, A., Wynn, M., Suriadi, S., Ouyang, C., & Karnon, J. (2015). Process mining for clinical processes: a comparative analysis of four Australian hospitals. ACM Transactions on Management Information Systems (TMIS), 5(4), 19.
Shah, F. A. and Rahman, W. (2016). The Effect of Training and Development Practices on Employees’ Organizational Commitment among the Employees in Private Health Care Sector in Khyber Pakhtunkhwa, Pakistan. Sarhad Journal of Management Sciences, 2(01), 17-26.
Talib, Y., Yang, R. J., & Rajagopalan, P. (2013). Evaluation of building performance for strategic facilities management in healthcare: a case study of a public hospital in Australia. Facilities, 31(13/14), 681-701.
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