Quality Management in Healthcare

Quality Management in Healthcare Services
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Structure: 1.1 Introduction Objectives 1.2 Overview of Quality 1.3 History of Quality Guilds of the medieval Europe Industrial revolution Beginning of 20th century 1.4 History of Quality in Healthcare 1.5 Scope of Quality in Healthcare 1.6 Quality Pioneers 1.7 Summary 1.8 Glossary 1.9 Terminal Questions 1.10 Answers 1.11 Case-Let
Introduction to Quality
1.1 Introduction
Quality means degree of excellence and depends on what the person perceives in a particular situation. The situation can be user-oriented, supplier oriented or cost oriented. Quality is an essential constituent of every activity in the organisation. Quality is considered as a high management priority; therefore, incorporates necessary strategies to improve the product or service quality. Quality will help to determine the organisations success through customer loyalty, strong brand reputation, fewer returns and replacements which will lead to reduced costs and also attract and retain good staff. The main aspects of quality include good design, good functionality and infrastructure, predictability, reliability, consistency, durability and value for money. Quality in healthcare is a patient-centered approach that can be used to deliver high-quality care as a basic human right. Quality in healthcare can be divided into three components they are: quality design, quality control and quality improvement. Quality design uses the planning tools first to define the organisation's mission, which includes understanding the customers
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needs and provides appropriate services, and then to provide the resources to achieve service delivery excellence. Quality control applies to monitor, supervise, and evaluate the methods to make sure that all activities comply with the set defined system resulting in high quality services being delivered. Quality improvement involves proactively understanding the stated and implied needs of the customer resulting in continual improvement. This unit familiarises you with the meaning, definition and history of quality. It discusses the history of quality in healthcare services. It also explains the scope of quality in healthcare services and lists the pioneers of quality. Objectives: After studying this unit, you should be able to: define quality recall the history of quality discuss the history of quality in healthcare services explain the scope of quality in healthcare services list the pioneers of quality
1.2 Overview of Quality

In scientific terms, the simplest meaning of quality is, the degree of adherence of a product or service to the predetermined specification. It may be termed good or bad, high or low, depending on the context of conformity to the expected criteria. Quality is broadly described as the comprehensive positive outcome of a product/service. However, in healthcare the product is multifaceted which contributes to different perceptions of quality. A precise definition of quality in healthcare acknowledges these differences and includes the care and services delivered and their perceived value to the consumer. According to Joint Commission on Accreditation of Healthcare Organisations (JCAHO), quality is defined as the degree to which health services for consumers increase the likelihood of the desired health outcomes and are consistent with the current professional knowledge. A patient, who is the prime focus in healthcare services, may perceive quality as the best possible treatment that is timely, safe and affordable, and can cater to his/her medical requirements. However, the International
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Organisation for Standardisation (ISO) defines quality as the totality of features and characteristics of a service that bear on its ability to satisfy the stated and implied needs of the patients. The above definition has two important factors: The totality of features and characteristics which means the combined net effect of the service on the patient or the consumer. The ability of the service to satisfy the stated and the implied needs of the patient; that means not just curing the present ailments of the patient but to treat and cure all the causative factors in order to restore their health to normal. In the context of health services the stated needs can be availability, accessibility, appropriateness, effectiveness, efficiency and affordability of the services to the community. The implied needs can be the kind of services that is comprehensive enough to address the needs of the customer resulting in customer/patient satisfaction. The following are some of the definitions of quality given by the quality pioneers: Dr. Joseph M. Juran: Quality is the fitness for use. Philip B. Crosby: specifications. Quality is the conformance to requirements or
Armand V. Feigenbaum: Quality is what the customer says it is. Self Assessment Questions 1. Quality is the fitness for use- this definition was given by _______. 2. JCAHO stands for ____________________________. 3. Quality is described as the comprehensive positive outcome of a product/service. (True/False)
1.3 History of Quality

The growth of quality can trace its origin back to medieval Europe, where the craftsmen began organising themselves into a group called Guilds in the late 13th century.
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Until the early 19th century, manufacturing in the industrialised world followed the craftsmanship framework. The factory system, with its accent on product inspection, started in Great Britain in the mid-1750s and later grew into the Industrial Revolution in the early 1800s. In the early 20th century, manufacturers began to include the quality processes in quality practices. Later, when United States entered into World War II, quality became an important component of the war exertion. For example, the bullets manufactured in one state had to work systematically in the rifles made in another. In the beginning, the armed forces inspected almost every unit of the product. Then, to simplify the process without compromising on the safety, they began to use sampling techniques for inspection. These techniques were aided by the publication of militaryspecification standards and training courses in Walter Shewharts Statistical Process Control (SPC) techniques. In the United States, the birth of total quality came as a direct reply to the quality revolution in Japan following the World War II. The Japanese accepted the comments of Americans like Joseph M. Juran and W. Edwards Deming, and instead of concentrating on inspection; they focused on improving all the organisational processes through the people who used them. By the 1970s, US industrial sectors like automobiles and electronics were impacted by Japans high-quality competition. In response to this, the U.S. emphasised not only on statistics but also on the approaches which embraced the entire organisation. This was later known as the Total Quality Management (TQM). In the 20th century, TQM was considered by many business leaders. Nevertheless, the use of the term TQM has reduced particularly in US. In few years, the quality movement seems to have developed beyond the scope of Total Quality. New quality systems have come into existence from the foundations of Deming, Juran and early Japanese practitioners of quality. 1.3.1 Guilds of the medieval Europe From the end of 13th century to the early 19th century, craftsmen all around medieval Europe were organised into groups called Guilds. They were
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responsible for developing the rigorous rules for product and service quality. Inspection committees implemented these rules by marking unflawed goods with a special mark. At first, this mark was used to track the origin of defective items. But over time, the mark was used to represent a craftsmans good reputation. For example, the stonemasons marks represented each guild members responsibility to satisfy his customers and also enhance the trades reputation. The inspection marks and the master-craftsmen marks functioned as a proof of quality for the customers all over medieval Europe. This approach was governing the quality until the Industrial Revolution in the early 19th century. 1.3.2 Industrial revolution The American quality practices took place in the 1800s as they were moulded by the changes in the dominant production methods like: Craftsmanship The factory system The taylor system Craftsmanship In the early 19th century, manufacturing in United States was inclined to follow the craftsmanship model used in the European countries. In this model, the young boys became well-versed in the skilled trade by serving as an apprentice for many years. Each of the craftsmen had a tremendous personal stake in meeting the customers need for quality. Since the goods were sold locally, the craftsmen were at a risk of losing their customers if they did not conform to the quality standards. Therefore, they maintained the form of quality by inspecting the goods before sale. Factory system - The factory system, a part of the Industrial Revolution in Europe, had begun to separate the craftsmen trades into specialised tasks. This had encouraged the craftsmen to become factory workers and the shop owners to become the production supervisors. In this system, quality was assured through the skill of labourers, regular audits and inspections. If necessary, the faulty products were either reworked or scrapped.
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Taylor system - Late in the 19th century, Frederick W. Taylor developed a new management approach that was adopted in the United States, breaking the European tradition. Taylors aim was to increase productivity without increasing the number of skilled craftsmen. He attained this by assigning factory planning to specialised engineers. He also used craftsmen and supervisors as inspectors and managers who executed the engineers plans. Taylors approach led to an outstanding rise in the productivity, but it had considerable drawbacks. The workers were once again deprived of their rights, and the new approach had a negative effect on the quality. 1.3.3 Beginning of 20th century The beginning of the 20th century marked the addition of processes in quality practices. Walter Shewhart, a statistician for Bell Laboratories, started to focus on controlling the processes in mid-1920s. He made quality relevant for both the finished product and the processes that created it. Shewhart recognised that the industrial processes yield data. For example, the procedure in which the metal is cut into sheets will result in certain measurements like each sheets length, height and thickness. Shewhart found out that this data could be analysed using statistical techniques to see whether the procedure is stable and in control, or if it is being affected by special causes. Being determined, Shewhart laid the foundation for the modern-day quality tool known as the Control Charts. World War II After entering into World War II, the United States endorsed a statute law to help gear the civilian economy to military production. At that time, the products were thoroughly checked on delivery to make sure that there was conformance to requirements. During this period, quality became a significant safety concern. Defective military equipment was clearly unacceptable and the U.S. armed forces inspected almost every unit produced to make sure that it was safe to use. This practice needed a lot of work force resulting in problems on recruiting and retaining competent inspection personnel. To eliminate the problems without any compromise in the product safety, the armed forces began to use sampling inspection methods to replace the unitSikkim Manipal University Page No. 6
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by-unit method. With the help of industry consultants, especially from Bell Laboratories, they modified the sampling tables and published them in the military standard. These tables were then integrated into the military contracts so that the suppliers could clearly understand what they were expected to produce. The armed forces also aided the suppliers to improve the quality by sponsoring training courses in Walter Shewharts Statistical Quality Control (SQC) techniques. Although the training courses led to some quality improvement in some organisations, most companies had the modest need to integrate the techniques. Activity: 1 Research on Web and prepare a report on the other historic events of quality that led to the development of healthcare services. (Hint: Refer to section 1.3 History of Quality) Self Assessment Questions 4. In medieval Europe, the craftsmen began organising themselves into a group called _______. 5. Shewhart laid the foundation for the modern-day quality tool known as the control charts. (True/False) 6. SQC stands for _________________.
1.4 History of Quality in Healthcare

According to Ellis and Whittington, there have been two conventions of quality in world history. They are the convention of quality in industry and the convention of quality in healthcare. With the widespread use of Total Quality Management (TQM) or Continuous Quality Improvement (CQI), healthcare is being assimilated by the industrial tradition. The following discusses the past, present and future trends in the journey of quality in healthcare. Past trends There is no clear indication in literature about when the development of quality in healthcare began. The historical literature about the industrial tradition will acknowledge that the quality activities are as old as the human
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race. The time spans which are used by the historians range from 30 years to 3000 years. The hard work of great minds like Atreya (in 800 BC), Sushruta (considered as the Father of Indian Surgery), Hippocrates (in 460370 BC) and Charak (in 200 AD) helped to improve the methods of treating the sick and suffering across the world. Their methods were simple and primitive which were targeted at improving the quality of care. Only few articles of healthcare will recognise that the quality can be traced to the beginning of recorded medical history. Edwin Chadwick (1800 1890) and Dr. Lemuel Shattuck (the Father of American Vital Statistics), through the scientific studies in the field of public health, linked the poor sanitary conditions to the shortage of qualified professionals in the field. Around 1854, during the Crimean war, a positive correlation between the quality of nursing care and mortality rate among the wounded soldiers was established by Florence Nightingale. An American Physician, Dr. Ernest Amory Codman introduced the concept of End Result like the mortality and morbidity. This is same as the present day outcome and developed the End Result Cards which is used for measuring the outcome of the individual cases. Present trends The birth of the modern concept of quality management in healthcare took place in 1918 when the American College of Surgeons began the Hospital Standardisation Program giving the criteria and standards for accreditation of the hospitals. The Joint Commission on Accreditation of Hospitals (JCAH) was started in 1952 which published the first accreditation standards and was made mandatory for all hospitals to obtain the JCAH accreditation standards. In 1947, the ISO was started with the objectives of facilitating international coordination and unification of industrial standards. Dr. Avedis Donabedian introduced the three measures called the Structure, Process and Outcome which emphasised the value of looking at the three measures while monitoring and assessing the quality of care. In 1966, the government of USA started the regulatory approach to quality in healthcare services with the passage of the Comprehensive Health Planning Act for linking the expenditure with better planning and Regional Medical Program Act for the provision of funds for care.
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Edward Deming introduced the concept of Total Quality Management (TQM) which was implemented in the healthcare industry. This method which is a management strategy can be described as a continuous effort by all the members of the organisation to meet the requirements and expectations of the customer. While explaining why modern quality assurance in the healthcare was an innovation of the U.S., Elizabeth DuVerlie, a consultant of the United States Agency for International Development Bureau for Global Health, points out that the quality assurance activities among the healthcare system reflects the structural differences which influence how the quality requirements arise and also how they are met. DuVerlie suggests that we can measure, define and manage quality by watching the evolution of activities in other countries. In the early 1990s, an increasing concern for quality in healthcare began. The consumers and purchasers of healthcare started demanding for comparative data on the performance of healthcare organisations. The international conferences organised by World Health Organisation (WHO) on aspects like the Quality in Primary Healthcare in China and the international consultation on Quality Assurance in District Healthcare in Korea helped to make quality in healthcare a global concern. Quality initiatives in India Quality assurance in healthcare in India was initiated at the Academy of Hospital Administration (AHA) for the first time which prepared a comprehensive manual for the accreditation of hospitals in 2005. The National Accreditation Board for Hospitals and Health Care providers (NABH) was established in 2006. It is an accreditation system which believes in patient-focused approach targeted at improvement in the process of delivery of care. It lays down certain quality standards and certifies the quality of outcome based on the conformity to prescribed standards. So, the accreditation by NABH is a certification of the level of quality treatment given to patients, that is, the patient care services and not just a certification of the existence of quality system. Credit Rating Information Services of India Ltd. (CRISIL) and Ananths directory of healthcare services have begun a system of rating hospitals based on the specialty or location.
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Future trends The field of quality in healthcare will continue to evolve and is rapidly expanding. This growth and development is the result of the current obsession with quality of care by the public and private sectors. This is called the third revolution in healthcare. The healthcare reform gives an opportunity to enhance the healthcare quality and to evaluate and manage it. Quality can be assured through the market place. The quality efforts should focus on the consumer choice through quality report cards and outcomes research should be disseminated. The quality components were proposed over the managed competition health reform, at the system-wide level, because of the resistance and hesitancy demonstrated by the individual organisations on the implementation of TQM. The Government Accounting Office (GAO) has estimated that it takes approximately one to five years for the service companies to recognise the advantages of TQM. The successful experiences in the healthcare organisations and in other industries have empowered employees. TQM may be finally accepted based on the customers suggestions and self-regulation can be achieved enterprise wide. Hence, quality will evolve from the external punitive methods of inspection to the internal and the self-regulatory approaches for personal growth and development. Self Assessment Questions 7. Father of Indian surgery is ________________. 8. The Father of American Vital Statistics is Edwin Chadwick. (True/False) 9. The concept of End Result like the mortality and morbidity was introduced by ______________.
1.5 Scope of Quality in Healthcare

There are three pillars in healthcare services; they are quality, access and cost. A quality service is one which is customer oriented. It is the service which is accessible, available, acceptable, affordable and effective. Quality can be achieved when the needs and the expectations of the patients are met. Quality of healthcare services has many values; they are as follows: Services planned and implemented for the community with equitable distribution of the resources. Judicious allocation of the resources to preventive, promotive, rehabilitative, curative and educative aspects which can have maximum
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impact in terms of minimising the morbidity and mortality among the whole community. This means that rather than spending major portion of funds on the highly expensive curative services, the focus should be on preventive services and treatment of common ailments that are relatively economical and also a benefit to the large mass. Facilities should be provided based on needs. In a developing country, there might be a lack of resources but the first priority should be to offer adequate facilities to attend the problems of the vast rural community, rather than spending enormous amount on costly equipment and medicines. Ensuring the availability and accessibility of basic healthcare facilities to the entire community in terms of reasonable response times. Providing affordable healthcare services. Many other factors play a vital role in determining the quality of services. Some of those include providing uniform care to the patients irrespective of the type of setting the patient is admitted in, respecting patients rights, complying to applicable legal and statutory requirements providing competent and requisite manpower, and infrastructure to name a few.
1.6 Quality Pioneers

The field of Quality Management is strongly influenced by a number of concepts developed by various Quality Pioneers. A quality pioneer is a person or a teacher, who has developed a concept or an approach to quality within the business that has made a major and lasting impact. The pioneers, from different countries, cited in this section have contributed immensely in the field of quality from time to time by developing their doctrines. The most widely known quality pioneers have been from America, Japan and the United Kingdom. Few names are given in Table 1.1.
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Quality Management in Healthcare Services Table 1 1: Quality Pioneers Country and Name Quality Pioneers Country Name of the Quality Pioneer Philip B. Crosby W. Edwards Deming Armand V. Feigenbaum Joseph M. Juran Walter A. Shewhart Abraham Flexner Dr. Lemuel Shattuck Kaoru Ishikawa Shigeo Shingo Genichi Taguchi John Groocock David Hutchins John Oakland Frank Price Lionel Stebbing Sir Edwin Chadwick Florence Nightingale
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United States of America
Japan
Europe
Some of the quality pioneers and their contributions to quality are as follows: Dr. Walter. A. Shewhart Dr. Walter A. Shewhart, an American physicist, engineer and statistician, spent his professional career at Western Electric and Bell Telephone Laboratories. He emphasised on Statistical Process Control (SPC). He also formulated the quality control chart theory with the control limits, assignable and chance causes of variation and rational subgroups. In 1931, he authored Economic Control of Quality of Manufactured Product, which is considered a complete and thorough work of the basic principles of quality control. He developed the famous Shewart Cycle also known as Plan-DoCheck-Act (PDCA) cycle for learning and improvement. This gave a new approach to quality improvement through efficient trial-and-error methodology. Shewharts work served as the foundation for the quality measures implemented by Dr. W. Edwards Deming and Dr. Joseph Juran. W. Edwards Deming W. Edwards Deming, an American statistician, is considered to be the Father of Quality Control in Japan. He was a famous worldwide management consultant for almost 40 years. He was responsible for
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revitalising the Japanese economy during the 1950s. He graduated in 1928 with a Ph.D. in Physics from Yale University. He worked with Walter Shewhart at Bell Laboratories and the Hawthorne Plant. He has been a hero to Japanese industry, although not all American industries have totally accepted his philosophy. Though many relate his name with the concept of Statistical Process Control (SPC), it is his entire philosophy and its implementation that has resulted in numerous successful companies. He defined quality as a predictable degree of uniformity and dependability at reduced cost and suited to the market. In 1986, Deming proposed a 14point plan to improve productivity and competiveness and also to help the top-level management to stay in business. Joseph M. Juran Dr. Joseph M. Juran, an American engineer, known as the quality Guru was one of the most important thinkers of the 20th century in quality management. In addition to Dr. Deming, Dr. Joseph M. Juran is also attributed with many contributions to the Japanese quality revolution. Jurans Trilogy defined the three management principles for improvement of quality - Quality Control, Quality Planning and Quality Improvement. Figure 1.1 explains Jurans Triology.
Figure 1.1: Jurans Trilogy
He was a lecturer and also worked with Walter Shewhart in the Hawthorne Plant in 1924. His philosophy focused on the fact that quality represented a universal concept called fitness for use. This philosophy is an important requirement of all products and services that meets the needs of the people who actually use them. In addition, the products and services must possess infinite factors that compose fitness for use, namely structural, sensory time oriented, commercial and ethical. Recognising his excellence and
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contribution the Juran Institute was founded in 1979. Juran enlightened the world on the concept of the vital few and trivial many which is the basis of Pareto Charts. Phillip B. Crosby Philip Crosby has been an advocate of quality, a highly recognised worldwide quality consultant, and the author of various quality books such as Quality Without Tears and Quality Is Free. In the 1980s, he guided and participated in many high-profile initiatives. He believes that the production of quality goods and services results in no additional cost to companies, but poor quality goods and services result in loss to companies. In addition, Crosbys philosophy focused on changing managements position toward more prominent standard of performance of zero defects, or the perpetual search for improvement. He believed in inspection and he found that management must not only shift their attitudes to prevention but communicate that this was achievable. Crosby, like Juran, supported quality cost measures, and he formed a set of quality-building tools. One of his quality-building tools includes the Management Maturity Grid, which is used to isolate areas for potential improvement. The four absolutes of quality are as follows: Quality is defined by the conformance to requirements. System for causing quality is prevention and not appraisal. Performance standards of zero defects which are not close enough. Measurement of quality is the cost of non-conformance. Dr. Armand V. Feigenbaum Dr. Armand V. Feigenbaum reasons that total quality control is necessary to achieve productivity, market penetration and competitive advantage. Quality starts with identifying the customers requirements and ends with a product or service in the hands of a satisfied customer. Some of Feigenbaums quality principles include; management participation, employee involvement, oversight leadership and quality control across the organisation, apart from customer satisfaction. He authored the book Total Quality Control in 1951. Kaoru Ishikawa Kaoru Ishikawa was a student of Deming, Juran and Feigenbaum. He developed the problem-solving tools for quality management process including the concept of quality control circles and the fishbone diagram. He
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adopted the total quality control concept and altered it for the Japanese. Ishikawa is best known for his cause and effect diagram or Fishbone diagram, which is sometimes called as Ishikawa diagram. Figure 1.2 depicts the cause-and-effect diagram.
Figure 1.2: Ishikawa Diagram
Kaoru Ishikawa also developed the quality circle concept in Japan, where work groups, including their supervisors, were trained in SPC concepts. These groups then met to identify and solve quality problems in their work environment. He presented that the true characteristics are the customers view and the substitute characteristics are the producers view. The degree of match between the true and substitute will ultimately determine the customer satisfaction. Abraham Flexner Abraham Flexner has made many contributions in the medical field. In 1910, through a study on medical education system, he pointed out the vital linkage between the quality of medical education of physicians and quality of patient care. He also outlined the quality criteria for medical schools which lead to the revolutionary reforms in medical education in USA. Dr. Lemuel Shattuck Dr.Lemuel Shattuck, father of American vital statistics system, started the concept of quality in the field of healthcare. Through a scientific study in the field of public health, he linked the poor sanitary conditions to the lack of qualified professionals in the health field. Florence Nightingale Florence Nightingale also known as the lady with the lamp played a vital role during the Crimean war. She established a positive correlation between the quality of nursing care and the mortality rate among the wounded
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soldiers. She managed to substantiate a direct relationship between the resources utilised and the quality of outcomes. The quality criteria laid down by her for nursing care was the first scientific and historical step in the evolution of the concept of quality in healthcare. Sir Edwin Chadwick Sir Edwin Chadwick was a social reformer and was noted for his work to reform the poor laws and also improve the sanitary conditions and public health. Chadwick believed in the improvement to public health because he thought that it would save money. He earned a place in the history of medicine by encouraging the government to involve in health promotions. Reforms in public health career like the improved sewers and water supply systems required the accommodation of the population growth related with the England's Industrial Revolution. He also sponsored the legislation which needed the government registration of the births, deaths and marriages. These records helped in tracking epidemics and other causes of death. Chadwick correlated such kind of vital statistics with the data about living the conditions to recognise the possible factors in disease causation. In 1889, Queen Victoria recognised his contribution to public healthcare and knighted him the first civilian Knight Commanders of the Most Honourable Order of the Bath. Activity: 2 R.J. Hospital is a new hospital started in Bangalore. It is concerned about the quality of services provided by them. Prepare a report on the quality improvement that the hospital can initiate. (Hint: Refer to section 1.5 Scope of Quality in Healthcare.) Self Assessment Questions 10. Jurans Trilogy defined Quality Control, Quality Planning and Quality Management. (True/False) 11. Shew0art Cycle also known as ______________ cycle. 12. Economic Control of Quality of Manufactured Product was authored by __________.
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1.7 Summary
Quality in healthcare can be summarised as follows: Quality in healthcare services has always been a concern in every society and country. Due to various factors, such as shortage of resources, lack of country specific healthcare accreditation norms and the lack of awareness among the public on health matters, the quality of healthcare never got the importance that it deserved. Market competition, increasing public awareness, criticism of the services being delivered and the demand for high quality services has been an impetus to the healthcare providers. Healthcare providers have started realising the benefits of having a good healthcare quality management system.
1.8 Glossary
Medieval: Equipment: Accreditation: It is belonging to the middle ages The special tools required for a particular purpose It is the act of accrediting or the state of being accredited, especially granting of approval to the institution of learning by an official review board after some particular requirements have been met It is the assessment by an authorised official.
Appraisal:
1.9 Terminal Questions

1. 2. 3. 4. 5. Explain quality in brief. Discuss the history of quality brief. Discuss the history of quality in healthcare in brief. Briefly explain the scope of quality in healthcare. Explain the contributions made by any two quality pioneers.
1.10 Answers
Self 1. 2. 3. Assessment Questions Juran Joint Commission on Accreditation of Healthcare Organisations True
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4. 5. 6. 7. 8. 9. 10. 11. 12.
Guilds True Statistical Quality Control Sushruta False Dr. Ernest Amory Codman False PDCA Dr. Walter A. Shewhart
Terminal Questions 1. Quality is broadly described as the comprehensive positive outcome of a product/service. Refer to section 1.2 for the same. 2. The growth of quality can trace its origin back to medieval Europe. This along with various periods of time led to the development of quality. Refer to section 1.3 for the same. 3. There are two conventions of quality in world history - the convention of quality in industry and the convention of quality in healthcare. The past, present and future trends in the journey of quality in healthcare. Refer to section 1.4 for the same. 4. There are three pillars in healthcare services; they are quality, access and cost. These along with other values of quality of healthcare services. Refer to section 1.5 for the same. 5. The pioneers, from different countries, have contributed immensely in the field of quality from time to time by developing their doctrines. Refer to section 1.6 for the same.
1.11 Case-Let
Need for Quality in Hospitals Star Hospital is in Gujarat. It is not a speciality hospital and lacks the basic facilities of a hospital. The patients in the hospital were not treated properly. The hospital is deficient with qualified nurses and only few qualified doctors were available. During emergencies, the patients were not treated properly because of the shortage of nursing staff. The in-patients were treated with out-dated drugs. The cost of treatment was very expensive for the patients. They
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were not following the procedure of providing a unique number for the treatment. This led to many problems, because if there were two patients with the same name then there used to be confusion while treating as well as billing the patients. All these issues were brought under the notice of the health authority of Gujarat. The health authority of Gujarat inspected the hospital and gave them a month time to improve their quality of service. They instructed the hospital management to increase the number of staff so that more qualified nurses are available to attend emergency cases. They instructed them to provide unique ID cards for the patients which would help in identifying each patient. They also asked them to maintain computerised records of the patients along with their details of payments so that there were no discrepancies in billing. The hospital worked on the flaws in their service. The hospital recruited more qualified and experienced nurses, and allotted them the departments as per their experiences. Nurses with two years of experience where recruited to the emergency ward so that the patients can receive necessary treatments immediately. The patients were given unique ID cards based on there first name, last name, date of birth and telephone number. This helped them to recognise each patient and serve them with the required treatment. The records department where asked to maintain a computerised records of all the patients which would include their past medical history details along with their present treatment details. This would also help them in the final billing. After a month, the health authority inspected the hospital. The hospital records did not show any kind of discrepancies and also only certified and trained nurses where recruited. The hospital started following a procedure of displaying the ID number on the patients wrist which helped them in providing the right kind of treatment to the patients. Discussion Questions 1. Where was the hospital going wrong in their service? (Hint: Refer to section 1.5 Scope of quality in healthcare.) 2. How did the hospital solve the problems? (Hint: Refer to section 1.5 Scope of quality in healthcare.)
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References Joshi S.K. (2007). Quality Management in Hospitals, First edition, India, Jaypee Publications. Nash D.B. and Goldfarb N. (2006). The Quality Solution: The Stakeholder's Guide to Improving Health Care, Second edition, USA, Jones and Bartlett Publishers. Graham N. O. (1995). Quality in Health Care: Theory, Application, and Evolution, First edition, USA, Aspen Publications. Lloyd R. C. (2004). Quality Health Care: A Guide to Developing and Using Indicators, First edition, US, Jones and Bartlett Publishers. E-References http://www.euro.who.int/__data/assets/pdf_file/0007/98233/E91397.pdf http://asq.org/learn-about-quality/history-ofquality/overview/overview.html
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