Total Quality Management (TQM) is one of the most prominent developments in mana
ID: 327794 • Letter: T
Question
Total Quality Management (TQM) is one of the most prominent developments in management for the past two decades. TQM started in Japan in the early 1980s and spread to the Western countries and Australia. In the 1990s, TQM topics became very important, and many companies were looking to apply TQM and use it to develop and improve their businesses.
Total Quality Management is defined as “a management philosophy concerned with people and work processes that focuses on customer satisfaction and improves organizational performance”
These days, health organizations face many challenges that can be classified into four major areas: increases in the cost of health services, rapidly growing technology dependence, pressure on health organizations to decrease costs and improve quality to cope with the international organizations that establish standards and give licenses and finally satisfying patients' needs, a major demand requiring hospitals to maintain high quality services.
Such challenges force health planners to adopt a system that can manage health care in a measurable way to offer a high quality service, which is the aim of the quality management programs in hospitals.
The system that can cope with all of these challenges and resolve all health organization's problems is TQM. Total Quality Management is also known as continuous quality improvement (CQI), quality improvement (QI), quality management (QM) and total quality control (TQC). Experts indicate that the key principles of TQM include the following: customer focus, obsession with quality, scientific approach, long-term commitment, teamwork, and continual improvement systems, education, and training, freedom through control, unity of purpose and employee involvement and empowerment. The liability of nursing personnel is mainly restricted in the implementation and evaluation of the TQM programs. Nurses represent more than eighty percent of the health workers in any Hospital. These nurses have played a significant role in the implementation and success of TQM programs.
Answer The Following Questions (Short Answer):
1-Describe the History of Total Quality Management (TQM).
2-What is Total Quality Management according to you?.
3-What are the challenges faced by Health Organizations in implementation of Quality Management Programs in Hospitals?.
4-What is the solution to the problems faced by Health Organizations these days?.
Explanation / Answer
Question1
The foundation of TQM can be traced back to early 1920s when statistical theory was first applied to product quality control. In the early 40s Americans (Deming, Juran, and Feigenbaum) developed this concept in Japan in the 40s. The shift in focus from product quality to quality of all issues within an organisation is considered as the start of TQM.
The history of total quality management (TQM) began initially as a term coined by the Naval Air Systems Command to describe its Japanese-style management approach to quality improvement. An umbrella methodology for continually improving the quality of all processes, it draws on a knowledge of the principles and practices of:
•The behavioral sciences
•The analysis of quantitative and nonquantitative data
•Economics theories
•Process analysis
The following shows the history of Total Quality Management, from inspection to business excellence.
1920s
Some of the first seeds of quality management were planted as the principles of scientific management swept through U.S. industry.
•Businesses clearly separated the processes of planning and carrying out the plan, and union opposition arose as workers were deprived of a voice in the conditions and functions of their work.
•The Hawthorne experiments in the late 1920s showed how worker productivity could be impacted by participation.
1930s
Walter Shewhart developed the methods for statistical analysis and control of quality.
1950s
W. Edwards Deming taught methods for statistical analysis and control of quality to Japanese engineers and executives. This can be considered the origin of TQM.
•Joseph M. Juran taught the concepts of controlling quality and managerial breakthrough.
•Armand V. Feigenbaum’s book Total Quality Control, a forerunner for the present understanding of TQM, was published.
•Philip B. Crosby’s promotion of zero defects paved the way for quality improvement in many companies.
1968
•The Japanese named their approach to total quality companywide quality control. It is around this time that the term quality management systems arises.
•Kaoru Ishikawa’s synthesis of the philosophy contributed to Japan’s ascendancy as a quality leader.
Today
TQM is the name for the philosophy of a broad and systemic approach to managing organizational quality.
• Quality standards such as the ISO 9000 series and quality award programs such as the Deming Prize and the Malcolm Baldrige National Quality Award specify principles and processes that comprise TQM.
?Question 2
According to me TQM is a belief system which an organization should follow. This beleif system is built on the foundation that every single employee in an organization is responsible for developing and maintaining quality in their services, products, or deliverables. This way this belief system works cohesively towards achieving the customer satisfaction.
Question 3&4
Challenge 1: Convince people that there's a problem
One fundamental, but often poorly met, challenge for improvement efforts is that of convincing healthcare workers that there is a real problem to be addressed. Clinicians and others may argue that the problem being targeted by an improvement intervention is not really a problem; that it is not a problem ‘around here’; or that there are far more important problems to be addressed before this one. Trying to convince clinical teams who think they are already doing well to change is likely to be futile unless they can be shown that action is really needed.
Those designing and planning interventions should be careful to target problems that are likely to be accepted as real. Possible strategies for establishing the problem as a problem include hard data to demonstrate its existence, patient stories to secure emotional engagement, engage the clinicians in defining what they would like to improve in their service and show that there is a ‘relative advantage’ in implementing the intervention
Summary:
Use hard data and to secure emotional engagement by using patient stories and voices.
Challenge 2: Convincing people that the solution chosen is the right one
Improvement interventions are often ‘essentially contested’: everyone may agree on the need for good quality but not on what defines good quality or how it should be achieved. Clinicians and others may resist change on grounds that interventions lack sufficient evidence or are incongruent with preferred ways of practising that already appear to deliver good results. Ensuring that there is good quality scientific evidence to support interventions, and that implementers are well briefed and capable of handling challenge, is therefore critical. One strategy for ensuring acceptability of interventions involves using well-facilitated forums to discuss and debate the evidence and expose it to challenge, rather than hoping that the evidence will ‘speak for itself’.28 ,29 It may also help if improvement efforts are underpinned by a clear and explicit ‘programme theory’8 —an account of the activities to be undertaken, and the causal links between these activities and the outcomes sought.30 Among other things, a programme theory makes explicit why an intervention is likely to work, and helps clarify focus and strategic direction. Considerable effort needs to be invested in the initial programme theory, but it should not be regarded as fixed and immutable; it may develop over time as those engaged in the programme learn from their experiences of implementation.24
Summary:
Come prepared with clear facts and figures, have convincing measures of impact and be able to demonstrate the advantages of your solution.
Challenge 3: Getting data collection and monitoring systems right
Data collection and feedback are indispensable to improving quality. Data help in demonstrating the scale of a quality problem and show what is happening in response to an intervention. But data collection, monitoring and feedback systems are remarkably hard to get right: they are often poorly understood, poorly designed and poorly implemented. Local teams may lack expertise and experience in collecting and interpreting data or they may struggle with systems that are designed for collecting administrative and clinical data but not for monitoring quality. Measures that are excessively burdensome, or not seen as credible by the target community, risk alienating, rather than engaging, clinicians and producing confusion about how far changes are real. Poorly chosen measures can also provoke gaming where participants are incentivised to produce the desired numbers without the intended changes in practice. Measurement systems need to be explicitly designed into improvement activities from the start, and they need to be adequately resourced. Systems need to be fit for purpose and avoid imposing excessive burdens or other unintended consequences, and staff need training on how to collect and interpret data.
Summary:
This always takes much more time and energy than anyone anticipates. It's worth investing heavily in data from the outset. Assess local systems, train people and have quality assurance.