QUALITY MANAGEMENT IN A

MULTI SPECIALITY HOSPITAL

SUBMITTED BY:

IRFANA . K

BATCH : B
 INTRODUCTION
Quality management has its root in manufacturing industries, due to its universal applicability, it
was believed that TQM principles and policies can be adapted to service industries as well. The
rising population and increasing standards of living of have driven significant growth within the
health care sector globally. Thus dynamic nature of the hospital industry and growing demand of the
customers made the hospital to focus on its quality issues seriously. Hence it become imperative to
the hospitals for professional management system to meet its customer needs. O ne of the important
services in the Global economy has been health. This is growing as most challenging sectors and
holds a key to the country’s overall progress. Quality has been shown to be an important element in
the consumers’ choice of hospitals. In light of these changes, there is an emerging need to improve
the quality of healthcare services. Further, the changing market and accreditation pressures have
motivated hospitals to implement TQM concepts. The TQM application in hospitals is seeking ways
to lower costs and improve care.

Quality of healthcare management depends upon many aspects of the healthcare organization like its
resources, its utilization processes and practices of the establishment to achieve maximum possible
clientele satisfaction. This is important for both the internal as well as and external stakeholders
especially for the patients in whom the final outcome is reflected by promotion of health, prevention
of disease, management of the sick with prompt diagnosis and treatment as well as by rehabilitative
measures simultaneously ensuring protection of community from the disease process in a cost
effective manner. Thus it is an onerous work of healthcare establishment (HCE) which must ensure
all above actions to claim its very existence and survival as physically tangible extension of medical
sciences ever fighting to arrest and cure disease process within humans specifically those of poor
and socially vulnerable community at all costs. The concept of quality is gaining increasing
importance in the production and consumption of products and services. Patients are less willing to
accept services without question or complaint, and hospital managers need proper managerial
practices to understand and record patients input and feedback in order to improve those services.

Customers want assurance that they are well cared for, that there will be no errors in their treatment,
and that they be valued as ‘patients’ in the hospital. Customers do not emphasize that the physical
facilities be appealing and that modern equipment be available Commitment to quality can fetch
more benefit towards the profit making and strategy development in the same time.
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

WHAT IS QUALITY

Quality is not a number but is a function of positive perception. Quality, simplistically, means that a
product should meet one‟srequirement.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”
INHERENT CHARACTERISTICS OF QUALITY

1. Providing products or service features that customers need. These features lead to customer
satisfaction and exceeding customer expectations, which, in turn, lead to increased revenue
for the producer. Ensuring Quality by adding features that customers want while ensuring
consistency and reliability with every iteration has a cost, but the cost of not embracing
Quality is much higher, including lost market share, missed opportunities, brand damage,
and recalls due to design and manufacturing flaws.
2. Designing features that are free from deficiencies and errors. Products or services that are
deficient and don’t work as they should require rework or, if they make it to the marketplace,
lead to costly recalls and customer dissatisfaction, all of which costs an organization money,
time, and brand integrity. Defects found at later stages of product development are far more
costly than if they had been found earlier.
3. Ensuring ongoing continuous improvement (CI) to address the root causes of defects that are
inherent in processes, tools, and designs and that have a significant impact. By addressing
the root causes through CI rather than the symptoms, organizations can reduce the Cost of
Quality, increase efficiency, sustain a Culture of Quality, minimize rework activities on the
shop floor and in the back office, reduce scrap, and ultimately have fewer recall events.
Revenue and overall market share then increase as a result of improved product quality,
higher levels of customer satisfaction, and increased market share.

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. Systematization of QM
8. Feed back and detailed recommendations

9. Quality criteria support quality management

WHY QUALITY MANAGEMENT IN HOSPITALS?

 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 alluring 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.

DIMENTIONS OF QUALITY

Joint commission on Accreditation of Health care organisations (JCAHO) has described the
following criterias as quality dimensions(safety, effectiveness, efficiency, timeliness, efficacy and
equity Respect and caring, availability, appropriateness).

CHALLENGES FACING BY TODAY’S MULTI SPECIALITY HOSPITALS

1) Financial challenges and hospital productivity: Hospitals are the second most energy-intensive
buildings after restaurants, and globally, healthcare costs are on the rise. These financial
challenges— in addition to an aging world population and increasing energy costs—are putting
pressure on healthcare organizations to do more with less without compromising quality of care.

2) Maintaining patient safety: Every year an estimated 20,000 people in the U.S. and 5,000 in the
U.K. die from an infection they received while in the hospital. Reducing the risk of infection, as well
as other potential risks, such as power failures, is crucial in ensuring a high quality of care and
maintaining the organization’s reputation.
3) Regulatory standards and emerging energy mandates: Noncompliance with regulatory
standards can lead to a disruption in operations, poor quality of care, safety issues, and substantial
fines. At the same time, as energy demand rises, many countries are requiring healthcare facilities to
reduce carbon output and meet mandates for energy reductions.

4) Hospital security: Healthcare facilities are often open 24/7, and those visiting are often under a
great deal of stress when life and health are at stake. Violence, infant abductions, patient
wanderings, and theft of drugs and hospital assets are major concerns.

5) Patient satisfaction: The well-being of patients is a key to reducing length of stay and preventing
readmissions. According to the American Society for Healthcare Engineering (ASHE), in green
hospitals, patients are discharged an average of 2.5 days earlier compared to traditional hospitals.
Additionally, patient satisfaction can also affect a hospital’s revenue. If the systems are operating
poorly or not at all, quality metrics such as Hospital Consumer Assessment of Healthcare Providers
and Systems can be adversely affected.

ADVANTAGE OF QUALITY

o Reduction in Improved care wastage

o Shorter lead times– Better team spirit

o Better relationship with– Less staff conflict, customers enhanced job

o Reduced cost, increased satisfaction profit– Increased efficiency

o Improved systems and– Confidence to standardized procedures clients

o Better workmanship,– less customer

o Guaranteed quality complaints,– lower rejection rates, less rework

HOSPITAL QUALITY SYSYTEM

COMPONENTS OF INTERNAL QUALITY SYSTEM

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.

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.

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.

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.)

DIFFERENT STAGES IN 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 9002certification 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.

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.

FUNDAMENTALS OF QUALITY MANAGEMENT IN HOSPITALS

Nowadays, the majority of authors agree that the development and implementation of the
quality management system in the healthcare organizations represents a revolutionary change
for organizations. Quality management affects the structure, core, internal and external,
ownership and customer (patient/client) relationships, the quality system and almost all
the other systems and segments of the organization. With that in mind, it is quite
reasonable that, in the last couple of decades, great progress has been made in organizing
business, which has led to the situation where organizations are increasingly oriented to
processes, rather than to the organizational structure .

First, healthcare services are specific because of the physical and mental
involvement of patients in the process of services providing. In other words, the
provision of healthcare services is based on continuous interaction between healthcare professionals
(doctors or medical technicians) and customer (patient/client). The customers may have a little
knowledge of the professional aspects of the services. The relationship between patients and
medical staff is the basis for creating input elements in the process. Whether the
patients will cooperate and, consequently, whether they will be satisfied with the provided service,
depends mainly on healthcare staff. Without effective patient/client inputs (their needs,
requirements and expectations, communication of its health status, potential adverse effects and
disorders), effective treatment is not possible. Payment and service provision are two
completely separate activities in healthcare. Paying for healthcare services is usually
done by a third party. Therefore, the healthcare service provider should satisfy
not only the requirements of the customer (patient/client), but also the person who
pays for that healthcare service (for example, healthcare insurance).

Healthcare services are characterized by the complexity of connections and interactions between
patients, clients, doctors and other healthcare workers, suppliers of medical and non-medical
equipment, materials and resources, healthcare insurance, legislative and other regulatory bodies.
QUALITY MANAGEMENT PRINCIPLES IN HOSPITALS

In today's global competitive market place, the majority of authors agree that the significant
number of quality programs began with a series of unplanned and uncoordinated activities,
rather than formulating philosophy or strategy. However, the existence of norms, some
rules and principles, as well as the implementation of some forms of sanctioning
for failure to maintain them, are necessary in order to successfully manage the organization.
Widely embraced as a quality management tool in a number of research areas, ranging from
social and behavioral sciences, economics and law to business and marketing, the notion that
quality management could be an effective tool in healthcare has received recent attention. basic
principles of quality management in healthcare:

Customer focus: Like any organization, every private and/or public healthcare organization, when
providing healthcare services, must respect the customer centered approach. This approach is an
important objective in the development of public and private services as it constitutes
one of the main drivers for healthcare services reforms . Customers are the ones for whom such
organizations exist and their needs, demands and expectations must be paid special attention.
Indeed, as the famous professor Deming, otherwise known as "the person who helped the success of
the Japanese revolution of quality", once noted - "everything starts and ends with the customer" .
Hence, healthcare services must be designed and developed according to the requirements,
needs and expectations of the customers (patients/clients), thus taking into account all the
requirements of the healthcare environment as well as the entire society.

Stakeholder involvement: Customers are not the only group whose needs and
requirements should be met. ''Adequate worth must also be provided to employees,
local and global community, investors and society in general, in terms of both
financial and non-financial aspects of a company's performance'' . Therefore, defining the healthcare
service, often, requires the identification of needs, expectations and requirements of all the
stakeholders and interested parties that, in addition to the service provider and health
insurance, include customer (patient/ client) as well as the physician and doctor.

Leadership: Another novelty brought with a new version of the ISO 9001 - leadership
is crucial for the management of the healthcare organizations and the quality
management system of those organizations that adopted customer centred approach.
Leaders have the role to inspire, promote and support the organizational culture of
quality. According to Filipović et al.,doctors are not the only ones who
contribute to the healthcare service quality.According to the same authors, the quality
improvement is equally contributed by doctors and managers - doctors in the field
of their professional practice and managers in the field of quality and safety of all the
services provided by the healthcare.

People and care vision: The exceptional role of employees in the organization is present in all areas
of life and work of the man. Drawing information, knowingly or
unconsciously, man creates values, beliefs and attitudes, and, guided by a variety of
external influences, makes decisions. This way, employees, as one of the most
valuable resources of today, become a powerful lever for strengthening the competitive advantage of
the majority of contemporary organizations in healthcare.

Process orientation: In recent times, the majority of authors agree that healthcare
services require the implementation of integrated and multidisciplinary processes that unite different
functions, clinical specialist activities as well as the variety of providers of healthcare services .
When it comes to understanding the process orientation, it is necessary to
understand some of the basic concepts that it carries with it. For instance, it is
necessary to introduce new roles, such as the owner, the bearer and the executor of
the process. It is necessary to introduce systems of evaluation and rewarding that
will be based on the achieved results of the process and not on the results achieved within the
individual organizational units.

Guidance through information: Nowadays, healthcare organizations exchange a great

number of different healthcare information and provide a great number of healthcare
services, all with the support of modern information technologies. In recent years,
there have been a growing number of international standards related to the application of certain
information technologies in the healthcare sector and the ISO organization has even formed several
technical committees in this field. Standardization of healthcare informatics indicates that data is
collected more efficiently and information is transmitted more effectively within the healthcare.

Partnerships for quality across healthcare services: When providing healthcare services, the
coordination is often nessesary between several healthcare organizations as providers of one
complex service. These may be two or three different healthcare organizations and,
sometimes, in a regional context, we can talk about a whole network of healthcare
organizations that, by networking at different levels, contain a "partnership for quality across
healthcare services". This all is realized in order to provide users with complete healthcare and cover
all the healthcare problems with appropriate specialist medical knowledge.

Demand oriented care: The fact is that the healthcare sector is much more specific,
but one of the basic specific characteristics in relation to which other profit
organizations differ in relation to healthcare is the importance of a proper
approach to determining the needs and expectations of customers. The definition of healthcare
services given in EN ISO 15224:2016 that describes them as "people
working for people" , support this claim. Therefore, the fundamental change hat must be
implemented in this sector is to change the treatment paradigm based on the opinion of the doctor
(without taking into account the patient's opinion) to the treatment based, particularly, on the needs,
demands and expectations of the customer.

Mutually beneficial supplier relationship: Third party services such as technical support,
information and communication services, business consulting, recruitment services, sanitation,
catering and training have a critical effect on the quality of healthcare organization and its outcomes.
As any quality service can be provided solely with the consideration of all the
known requests from all the stakeholders and interested parties, mutually beneficial relationships
with suppliers in healthcare have received recent attention.

Continual improvement: According to ISO 9001:2015 - "The organization shall continually

improve the suitability, adequacy and effectiveness of the quality management system" . Hence, all
the healthcare organizations must also focus on this principle that encourages learning, contributes
to the development and continual improvement of the healthcare.

APPROACHES USED TO IMPROVE QUALITY AND PATIENT SAFETY IN

MULTI SPECIALITY HOSPITALS

Increasing resources: increasing the financing, personnel, facilities or equipment used in a hospital
or health system, with the aim of treating more patients or treating the same number faster, better
and at lower cost-per-person.
Large-scale reorganization or financial reform: changing the structure of a hospital or health
system so as to facilitate better decision-making or use of resources. Changes in financing methods
are made as a way of improving quality.

Strengthening management: improving quality by increasing management responsibilities,

authority or competencies. It is sometimes used as part of other types of strategy.

Standards and guidelines: formulating standards of what is expected from health providers,
communicating, providing training in, and enforcing the standards.

Patient empowerment and rights: giving patients a voice, for example through complaints systems
or patient satisfaction questionnaires, as well as publicizing what patients have a right to expect.
There may also be methods to strengthen patient power through legal entitlement, advocacy or other
institutions, such as a right to treatment within 30 minutes of arriving at an emergency room.

Quality management system: defines responsibilities for quality and puts into place the structures
and systems to ensure it. The International Organization for Standardization (ISO) issues guidelines
used by some European hospitals to design quality management systems . The composition of such
a system is interpreted differently from country to country in the absence of overarching standards.

Quality assessment and accreditation, internal or external: There are many assessment systems
This may or may not involve issuing formal accreditation. Accreditation systems differ in which aspects of
hospital operations are assessed and whether quality outcomes are considered in the assessment.

Total quality management (TQM) and continuous quality improvement (CQI): TQM is a set of
principles and methods applied in many different ways, originating from organization-wide
industrial quality programmes. This strategy focuses on attention of personnel and on providing the
best patient experience and outcomes. Quality tools are used by multidisciplinary teams of workers
to make changes, and the approach is generally thought to require strong management leadership. It
is based on a view that quality problems are more often due to poor organization than to individual
faults . CQI is the same as TQM in most literature, although it sometimes refers to a concentration
on multidisciplinary project teams analysing work processes and using repeated cycles of testing
small changes .

Quality collaboratives: a national and regional strategy in Australia, Norway, Sweden and the
United States, promoted by United Kingdom’s National Health Service, and being tested in middle-
income developing countries . The strategy is to bring together project teams from many different
hospitals. The teams typically meet every 3 months over 9 months to learn and apply quality
methods and to report their progress . It was devised to provide an economical way to learn models
of effective practice and quality methods, to stimulate enthusiasm and get faster results than are
usually obtained by CQI/TQM strategies .

Re-engineering: uses some of the TQM methods, but includes a more radical redesign of
“production processes” than the TQM approach, which normally involves small-scale and
incrementally tested changes .

Quality indicator comparison: seeks to motivate patients, clinicians and others to use information
about quality to make improvements, but is not prescriptive. It can be used by one hospital taking
part in a comparative data gathering programme , or as a voluntary or compulsory strategy for
hospitals in an area to collect and report the same data. Some comparison systems are public and
promoted to encourage both patients and providers to take action to improve quality .

Benchmarking: uses comparative information about quality with additional methods to help
providers decide how to improve quality. There are specific methods for identifying, documenting
and applying the best practices.

Risk management and safety: identifies high risk procedures or situations that put the hospital at
financial risk from patient claims . It includes methods for diagnosing causes of adverse events.
Patient safety strategies often include risk management and a wide range of methods from other
industries for collecting and analysing adverse event or near miss reports with a view to prevention.

CONCLUSION
Importance and its applications Quality management is a vital element for the accomplishment of
any business. Items and administrations are additionally critical parts of value administration.
Regardless of what a specific association offers, quality is a fundamental piece of it. Clients expect
great items and services and need to realize that their well deserved cash is going toward something
that won't just profit them now, however will benefit them for a long term. Services or products of
high quality always mean achievement for an organization. Happy and satisfied clients will be the
ones who be associated with the brand for a long term and that is the thing that each association
takes a stab at toward the day's end. Quality management is a procedure that must get steady
consideration keeping in mind the end goal is to be effective. That is the reason there are workers
given to controlling, keeping up, and enhancing quality on a continuous premise.