The presentation describes in a comprehensive manner the various aspects of quality and how to develop a quality assurance system in the hospital.

1. QUALITY ASSURANCE IN
HOSPITAL
DR. N. C DAS

2. 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

3. QUALITY
QUANTUM
UPHOLD
ASSURED
LEVEL
IN
TEST
YEILD
Dr.N.C.DAS

4. WHAT IS QUALITY
Quality is not a number but is a function of positive perception.
Quality, simplistically, means that a product should meet one‟s
requirement.
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.

5. 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”.
DR. N.C DAS

6. 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. Systematisation of QM;
8. Feed back and detailed recommendations;
9. Quality criteria support quality management;

7. WHY QUALITY
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 allouring 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..

8. QUALITY ASSURANCE
SYSTEM
DR. N. C. DAS

9. QUALITY
QUANTUM
UPHOLD
ASSURED
LEVEL
IN
TEST
YEILD
Dr.N.C.DAS

10. WHAT IS QUALITY
Quality is not a number but is a function of positive perception.
Quality, simplistically, means that a product should meet one‟s
requirement.
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.

11. DIFFERENT PERCEPTION OF QUALITY
PROVIDER RECEIVER ORGANISER
• To provide care as per • Accessibility • Social Equity
established norms • Affordability • Effective public
• Doing the right thing resource utilization
• Prompt attention
• Doing it the right way • Standardised care
• Doing it right the first • Less waiting time • Cost contentment
time • Receiving the right •Satisfaction of both
• Doing it on time service for their use provider and receiver
without exceeding cost • Being satisfied that their • Fruitful outcome
• Availability of needs have been met • Profit margin
Adequate resources • Early cure and return to
• Satisfaction with the work
final outcome • Being treated with
• Helps in improving integrity, courtesy and
skills, efficiency and respect
experience

12. DIMENTIONS OF QUALITY
Joint commission on Accreditation of Health care organisations (JCAHO) has
described the following criteria's as quality dimensions
(safety, effectiveness, efficiency, timeliness, efficacy and equity
Respect and caring, availability, appropriateness),
RESPECT AND
SAFETY TIMELINESS
CARING
EFFICACY EFFECTIVENESS EFFICIENCY
APPROPRIATENES
CONTINUITY AVAILABILITY S/ EQUITY

13. WHY QUALITY IS NEEDED
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 allouring 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..

14. ADVANTAGE OF QUALITY
– Reduction in • Improved care
wastage • Shorter lead times
– Better team spirit • Better relationship with
– Less staff conflict, customers
enhanced job • Reduced cost, increased
satisfaction profit
– Increased efficiency • Improved systems and
– Confidence to standardized procedures
clients, • Better workmanship,
– less customer • Guaranteed quality
complaints,
– lower rejection rates,
less rework

15. 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. Systematisation of QM;
8. Feed back and detailed recommendations;
9. Quality criteria support quality management;

16. PARTS OF THE QUALITY SYSTEM
Organization Personnel Equipment
Process
Purchasing Control Information
(QC & EQA)
& Inventory & Specimen
Manageme
Management nt
Documents Occurrence
Management Assessme
& Records
nt
Process Customer Facilities &
Improvement Service Safety
CDC

17. COMPONENTS OF QUALITY
SYSTEM
PROMOTING QUALITY CORRECTING QUALITY
QUALITY SYSTEM
Determination Promotion Policy and Beneficiaries
of empowerment
of Quality management
standards and
requirement and decision
making participation
guidelines
Regulations Health
Management outcomes
systems for
Payment Quality
Practices monitoring
quality System mgt. Satisfaction
Information Complaints

18. HOSPITAL QUALITY SYSTEM
QYALITY SYSTEM
INTERNAL EXTENAL
QUALITY SYSTEM QUALITY SYSTEM
ORG STRUCTURE HOSPITAL ACREDITATION
SAFETY, EFFECTIVENESS, ISO CERTIFICATION
EFFICIENCY, TIMELINESS, EXTERNAL MEDICAL
PATIENT-FUCUSED EQUITY AUDIT

19. COMPONENTS OF INTERNAL
QUALITY SYSTE
OUTCOMES
STRUCTURE PROCESSES
OF CARE
INPUTS STEPS OUTPUTS
•Patients •Inventory Methods •Physiologic
•Equipment •Coordination parameters
•Supplies •Physician orders •Functional status
•Training •Nursing Care
•Environment •Ancillary staff OUT COME
•Housekeeping
•Transport • Patient
Satisfaction
•Cost

20. INPUT---PROCESS----OUTPUT
A. INPUT
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.
B. 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.
C. 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.

21. D. 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.)

22. INTERNAL QUALITY SYSTEM
IN PUT PROCESS OUTPUT
i). QUALITY
i). PERSONNEL i). SOP Error of
ii) MATERIAL ii). INTER treatment./Death
iii) SUPPLIES PERSONAL Complication
iv). FINANCE
v). TECHNOLOGY
RELATION LAMA, AVLS
vi). RULES AND iii). ART OF CARE ii). QUANTITY
REGULATIONS iv). MANAGEMENT BTR, BOR, OT
TECHNIQUES Disability
v).DOCUMENTATION iii). COST
iv). CONSUMER
SATISFACTION
INPUT PROCESS OUT PUT
CONTROL CONTROL CONTROL

23. COMPONENTS OF QUALITY SYSTEM
1. INPUTS
•Adequate buildings and working space
•Necessary equipments always available and functioning
•Necessary medications and medical supplies always available
•personnel
•Anybody who touches the patient or a relevant process in the system:-
Departments, physicians, clerks, pharmacy, nursing, OT, ICU, care technicians,
phlebotomist, patient transport, administration
2. PROCESSES
•All those affecting relevant aspects of patient care:-
Clinical decision making, order writing, admission intake, medication delivery,
direct patient care, discharge planning, communication, discharge follow-up, etc
3. 4. OUTPUT
•Which are the end result of the process :-
Physiologic parameters, (Meeting standards )
functional status, (Efficiency, Effectiveness, Quality)
5. OUTCOME
Which are the end result of the output
Patient satisfaction ,Cost

24. QUALITY SYSTEM
Quality does not happen by chance
Quality needs to be systematically
developed
With objective planning, staff
involvement and considering patient
need.

25. DEVELOPING A QUALITY SYSTEM
Quality system
Quality Manual
Quality procedures
Quality plan
Quality audit

26. 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 9002
certification 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.

27. QUALITY SYSTEM
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.

28. 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.

29. ELEMENTS OF QUALITY
MANAGEMENT
Errors in the hospital are invariably due to system failure in85% of
cases(Edward Deming).
Only 15% are attributed to people‟s performance.
Therefore attention should be given on bad system than bad people.
Improvement of systemic errors can be done by:-
Commitment of TOP Management,
Active support of Middle Management.
Education and training of staff.
Formation of quality management team.
Developing Quality culture in the work place.
Making aware all staff about the goal and objective of the organisation.
Developing quality policy and quality manual.
Developing Standard Operating Procedure for all areas (SOP) .
Good Hospital Information System (HIS).
Formulation of criterias and Standards for Measuring activities.
Constant monitoring and Supervision and feed back.
Introducing Medical Audit System.
Rectification of errors and Evaluation.
External quality control.

30. COMPONENTS OF QUALITY MANAGEMENT SYSTEM
QUALITY QUALITY
PLANNING CONTROL
SYSTEM
PATIENT NEED
QUALITY SATISFACTION QUALITY
IMPROVEMENT ASSURANCE
TOTAL QUALITY
MANAGEMENT

31. COMPONENTS OF QUALITY PLANNING
POLICY STATEMENT RISKS AND
ON QUALITY RISK MANAGEMENT
PLANNING
RECORDS AND
DOCUMENTATION QUALITY MANUAL
WORK INSTRUCTION
OR
WORK SHEET SOP

32. 4 TIER QMS DOCUMENTATION
QUALITY MANUAL
TIER-1
(objectives, policies, philosophies)
PROCEDURES MANUAL
TIER-2
(purpose, scope, standard)
JOB INSTRUCTIONS
TIER-3
(work sheet/specific work instructions)
TIER-4 FORMS & RECORDS

33. QUALITY MANUAL CONTENTS
AIMS AND STANDARDS LEVEL OF
MANAGEMENT
OBJECTIVES AND CRITERIA
SYSTEM CONTROL
CORECTION JOB
AND DESCRIPTION
EVALUATION
QUALITY
MANUAL
MONITORING DEVELOPING
AND HIS
SUPERVISION
QUALITY QUALITY ORGN. TRAINING
MEASUREMENTS DIMENTIONS ANALYSIS

34. 1.ORGANISATIONAL ANALYSIS
Organisation structure must meet the organisational functions and Objectives.
Review organisational relationship with its external environment.
Analyse organisational structure with respect to Hierarchy, span of control ,
Authority and delegation.
Functions, Work distributions and accountability.
Identify Problem areas, analyse to understand the „Cause and Effect‟ for suitable
remedial measures.
2. TRAINING
Train the management about quality System.
Train the Quality monitoring team.
Training of staff how to maintain quality at work place and their specific roll.
3. DEVELOP HIS
i) Hospital operation Statistics.
- Hospital Resources and their utilization.
- Administrative and financial data.
ii). Hospital Morbidity Statistics.
- Patient characteristics
- AVLS, BTR, BOR, Infection rates.
- Consultations, complications and Errors.
- Type of treatment, investigations.
- Outcome of hospital stay, Events, Death/ Discharge.

35. FORMULATION OF CRITERIA AND
STANDARDS
INDICATRES AREAS
Prevention Ambulatory care sensitive
Quality Indicators Conditions, House keeping,
HIC. BMW disposal.
Inpatient Quality Mortality following
Indicators ( PROCESS) procedures
Mortality for medical
conditions
Utilization of procedures
Volume of procedures
Patient Safety Post-operative
Indicators complications
Iatrogenic conditions/Errors.

36. SERVICE QUALITY MEASUREMENT
STRUCTURE PROCESS OUT COME
i). QUALITY OF CARE
i). STRUCTURE i). PHYSICIAN AND ERRORS
DESIGN PATIENT INFECTIONS
ii). RESOURCES INTERACTION DEATHS
-BEDS ii). INTER- ii). QUANTITY OF
-PERSONNEL PERSONAL CARE
-- SUPLIES RELATION No. OF PATIENTS
-- Finance TREATED
iii). TECHNIQUES
NO. OF OPERATION
-- EQUIPMENTS AND NUMBER OF PATIENT
-- SPACE PROCEDURES REFUSED ADMISSION
iii). TECHNOLOGY iv). TOTAL QUALITY Iii). COST OF CARE
iv). RULES MANAGEMENT COST PER BED
v). PROCEDURES (TQM) COST PER PATIENT
iv). PATIENT
SATISFACTION

37. TYPICAL QUALITY RECORDS
QS Elements ISO 9001 Quality Records
ref:
Mgt responsibility 4.1 Mins. of mgt review
Quality system 4.2 QM,PM, PQP,JI/SWI
Contract review 4.3 Mins. of tender review
Design control 4.4 Design plan, inputs,…
Doc & data control 4.5 Register-files, sigs,revs
Purchasing 4.6 Register of acceptable subs
Control of Cost 4.7 Cost verification records

38. QS Elements ISO 9001 ref: Quality Records
Ident & Traceable 4.8 Product/batch records
Process control 4.9 MS, stds, qualifications
Inspection & Testing 4.10 ITP, insp reports
Control of insp, 4.11 Register of equipments and
measuring & test cal. certificates
equip
Insp. & Test status 4.12 Job cards, progress insp
rep.
Control of complains 4.13 Com reports, defects
reports
Corrective & Prev A 4.14 Corrective action reports

39. QS Elements ISO 9001 ref: Quality Records
Hdlg, storage, 4.15 Delivery notes, dispatch
packaging, presv, del advices
Control of quality 4.16 Insp./test reports, audits
records reports
Internal quality audits 4.17 Audit reports, CAR
Training 4.18 Qualification records,
training course records
Servicing 4.19 Visit reports, maint. Logs,
Stats. techniques 4.20 Control charts

40. QUALITY CONTROL
•QC is product oriented Activity
•Quality Control (QC) is a system of routine technical evaluation, to
measure and control the quality of the product as it is being developed.
•A set of activities designed to evaluate a finished work product/service.
•QC activities focus on finding defects in specific out puts - e.g., are the
defined requirements the right requirements have been met.
•QC is set of activities whose purpose is to ensure that all quality
requirements are being met that is defect detection, and done by testing
•Quality Control is mainly an inspection function.
•QC is product/output Oriented Activity
•It is a processes and methods used to compare product quality to
requirements and applicable standard
•Action taken when a non conformance is detected

41. QUALITY CONTROL
Evaluation of planned or systemic actions to provide enough
confidence that a product or service has satisfied the given
requirements of quality as pre- determined.
IDENTIFY THE SERVICE/ PRODUCT
MATCH INDICATORS
COMPARE WITH ESTABLISH
STANDARD
EVALUATE OUTPUT
QUALITY ACHIEVED QUALITY NOT ACHIVED
REVIEW THE PROCESS &
ENHANCE STANDARD AREAS OF IMPROVEMENT

42. QUALITY ASSURANCE
•QA is process oriented Activity
•It is a planned system of monitoring procedures of process conducted
by personnel not directly involved in the inventory compilation/development
process.
•A set of activities designed to ensure that the development and/or
maintenance process is adequate to ensure a system will meet its
objectives.
•QA activities ensure that the process is defined and appropriate.
Methodology and standards development are examples of QA activities.
•A QA review would focus on the process elements of a project - e.g., are
requirements being defined at the proper level of detail.
•QA is set of activities whose purpose is to demonstrate that an entity
meets all quality requirements.
•This is done by adopting a standard set of process and usual QA
techniques like review, training, facilitation etc.
•It can be termed as defect prevention.
•Quality assurance is an audit function.

43. QUALITY ASSURANCE
•A set of activities designed to ensure that the development
and/or maintenance process is adequate to ensure a system
will meet its objectives.
INPUT PROCESS OUTPUT
IDENTIFY THE
PUT THE SYSTEM MONITOR THE OUTPUT
PROCESS
INTO ACTION AND STANDARD AND
SET THE PROTOCOL MONITOR AS PER COMPARE TO
SOPs SET QUALITY LEVEL
PREPARE SOP
SET QUALITY
LEVEL

44. QUALITY CONTROL vs. ASSURANCE
QUALITY CONTROL QUALITY ASSURANCE
•
• QC is product oriented Activity
QA is process oriented Activity
• A set of activities designed to ensure
• A set of activities designed to evaluate
that the development and/or
a developed work product.
maintenance process is adequate to
• QC activities focus on finding defects ensure a system will meet its
in specific deliverables - e.g., are the objectives
defined requirements the right
• It ensure that the process is defined
requirements
and appropriate. Methodology and
• After manufacturing the product, the standards development are examples
quality control process begins. of QA activities.
• quality control follows the guidelines • It focus on the process elements of a
and standards established by project - e.g., are requirements being
assurance of quality department to defined at the proper level of detail.
check whether output meet the quality
• is meant to produce defect-free goods
requirements or not.
or services which means being right
• Depending upon the results, suitable the first time with no or minimum
corrective action is taken by quality rework.
control personals.

45. QUALITY CONTROL vs ASSURANCE
QUALITY CONTROL QUALITY ASSURANCE
• Quality control ensures that these • quality assurance process is a series of
defined standards are followed at steps taken at the different stages of the
every step. product life cycle i.e. from the product
concept to the launch of the product to its
• It is focused on detecting the defects obsolescence.
once the product is manufactured. • Assurance of quality is a set of preventive
• Quality control is a failure detection activities, which are focused on processes
system that uses a testing technique • Assurance defines the standards to be
to identify errors or flaws in products followed
• some process parameters cannot be • Quality guarantee department develops all
the planning processes and procedures to
controlled and here is where quality
make sure that the output is of good quality
control comes into picture.
• Assurance of quality is a failure prevention
• Quality control is a corrective process system that predicts safety, quality
• The processes of quality control standards and legality
involve calibration, sampling and • Quality guarantee processes involve
documenting reviews and giving implementing real-time quality checks in
feedback for improvement every department
• It is a monitoring process
• It is an Evaluation process

46. QUALITY IMPROVEMENT
Maintaining the process of quality standards through
out and efforts made to improve upon is termed as
„continuous quality improvement‟.
Continuous quality improvement is therefore a key
component of successful management technique.
There are four “quality improvement initiatives” that
hospitals could use as a yardstick to achieve the best
outcomes:-
 Nurses must be actively involved throughout the
process,
 Quality outcomes should be transparent,
 Decisions must be supported by quality research,
 Staff should feel empowered to make decisions and
be held accountable

47. QUALITY IMPROVEMENT PLAN
The quality improvement plan emphasizes on three
aspects for continuous improvement
SYSTEM
SERVICE/PRODUCT PEOPLE‟S
IMPROVEMENT IMPROVEMENT
1. Quality of supplies
2. Sterile procedure 1. Motivation & leadership
3. Working Environment PROCESS 2. In service training & skill
4. Proper maintenance of IMPROVEMENT developments.
records 3. Awards & recognition
5. SOPs 4. Seminar & work shops
Inpatient Quality
6. Use of latest technique for 5. Empowerment of people
Indicators (IQIs)
separation Prevention Quality
Indicators (PQIs)
Patient Safety Indicators
(PSIs)

48. COMPONENTS OF IMPROVEMENT
A. SERVICE IMPROVEMENT
 Can be done through introducing latest technology and machines
 Ensuring supplies at right time at right place in right quantity.
 Regular maintenance and standardisation of equipments.
 Implementing standard operating procedure.
B. PROCESS IMPROVEMENT
 Introducing suitable modern management techniques
 Follow ISO certification guide lines
 Get the certification from NABH
 Define clear cut job responsibilities.
 Fix accountability.
 Detect problems early and solve it.
C . PEOPLES IMPROVEMENT
 Develop regular staff training program
 Onsite training of staff at work place.
 Develop staff work culture
 Introduce quality circle discussions.
 Inculcate team spirit, leadership and motivation among workers.

49. TOTAL QUALITY MANAGEMENT
T – Take the entire organization, patient, staff and its activities
into consideration.
Q – Quantum output to meet pre- determined standard/
objective.
M – Manage step by step i.e. Planning, Organizing, Controlling,
Provisioning, Staffing.

50. •Determine goals & priorities .Apply the plan
•Determine processes •Train & educate the workers
•determine tracking indicators •Monitor tracking indicators
•Take action to eliminate any problems
•Standardize process if successful •Check results of
•If not Plan future improvements implemented plan
•Identify any problems
TQM CYCLE

51. WHAT IS TOTAL QUALITY MANAGEMENT
Total Quality Management is that aspect of the overall management
function that determines and implements the quality policy.
1. It is a business management strategy aimed at embedding
awareness of quality in the entire organizational process.
2. It is defined as a combination of organization functions and
management techniques centered on quality, based on the
participation of all members focusing on long term success
through meeting customer needs, satisfaction and
organizational objective.
3. Quality management takes in to consideration PEOPLE,
PROCESS and PRODUCT
When along with these three elements Patients need is also taken into
consideration
It is termed as „TOTAL QUALITY MANAGEMENT‟
OBJECTIVE: Do the right things, right the first time, every time and
reduce losses due to wasteful practices.

52. FOUR “Ps” OF TQM
Peoples Process
Commitment Improvement
TQM
Patients Need Product
Satisfaction
In time

53. PRINCIPLES OF TQM
C – Commitment by top management
O – Organization and structure for TQM
N - Normal financial control activities
S – Supplier relationships initiative
T – Training, education and safety awareness of staff
R – Relationships cordial with customers
U – understanding and commitment by employees
C – Communications net working
T – Teamwork encouragement
I – Independent certification level to ISO 9000
O – Objective measurement of functions
N – Natural use of tools and techniques and skills

54. SUCCESS OF TOTAL QUALITY MANAGEMENT
TQM
MANAGEMENT AND CULTURE
EMPLOYEE
STAFF COMMITMENT
EMPOWERMENT
LEADERSHIP
AT TQM QUICK
TOP SUCCESS RESPONSE
FACT BASED
CUSTOMER DECISION
FOCUS MAKING
CONTINOUS
IMPROVEMENT

55. DEVELOPING TQM CULTURE
All departments of the hospital were asked to compile a list of
quality problems
Review of the list by the Hospital Quality Committee
Provide feedback to the departments and support departments for
the analysis of problems and design of solutions
HOSPITAL QUALITY COMMITTEE
Establish a Comprehensive quality plan for the Hospital in close
cooperation with departments
Initiate, coordinate and support Quality Groups in the various
hospital departments
To give advice to Quality Groups for developing their action plans
Support implementation of action plans of the Quality Groups
Motivation and appraisal of Quality Groups
Feedback to Hospital Management Team
Establish quality circles in all departments
Train more staff with QM skills
Work on the problems with each department

56. QUALITY CIRCLES(QC)
• SIGNIFICANCE OF QC:
I. UTILISING EDUCATION,EXPERIENCE AND CREATIVITY.
• QC –AN INTEGRATED PROGRAMME:
1. MEMBERS
2. CIRCLE LEADERS
3. FACILITATORS
4. CO-ORDINATOR
5. STEERING COMMITTEE
• PROCESS
a) PROBLEM IDENTIFICATION
b) PROBLEM SELECTION
c) PROBLEM ANALYSIS
d) IMPLEMENTATION &RECOMMENDATION TO THE
MANAGEMENT.
QC ENVISAGES PARTICIPATORY MANAGEMENT STYLE
WITH A “BOTTOM UP” APPROACH.

57. TQM - CULTURE
COMMITMENT TO
MANAGEMENT OF REDUCE MEETING
EMPLOYEES PROCESSING COUSTOMER
TIME AND COST NEED
FINISH IN
SET PREDETERMINE
NEW TARGET TIME
TQM
ACTIVITIES
CUSTOMER
RECOGNITION SATISFACTION
& AWARD
IMPROVE IMPROVE
EMPLOYEES
EMPOWERMENT PLAN SYSTEM

58. QUALITY MANAGEMENT vs. TQM
Quality element Previous state (Traditional) Total Quality Management
Definition Product oriented Customer oriented
Priorities Second to service and Cost First among the equals of
service and cost
Decisions Short term Long term
Source: Basterfieldet al, 2002 pp3)
Emphasis Detection Prevention
Errors Operations System
Responsibility Quality Control Every one
Problem solving Managers Teams
Procurement Price Life cycle costs, partnership
Manager‟s Role Plan, assign, control and Delegate, coach, facilitate and
enforce mentor

59. • Inadequate financing • Inadequate M3
• An expenditure and not • Large gap between demand &
investment supply
• No regionalisation of Med • Lack of motivation, misuse &
care policy pilferage.
• No strict referral system • Poor budgetary planning
• Political and beaurocrate •Unionism internal conflicts
interference • Lack of latest gadgets
• Lack of regular re-orientation • Poor handling Of
• training in advancement of grievances/complaints
technology • Lack of standing
guidelines/procedures
• evaluation of care from
patient/relatives DR.N.C.DAS

60. QUALITY DIAMOND
(FOUR ELEMENTS OF QUALITY SERVICE)
CUSTOMER
SATISFACTION
CONTINUITY COMMITMENT
IN IMPROVEMENT OF STAFF
QUALITY
DIAMOND
EXPECTATION
OF PATIENT
AND STAFF

61. hospiad
Hospital Administration Made Easy
http//hospiad.blogspot.com
An effort solely to help students and aspirants
in their attempt to become a successful
Hospital Administrator.
DR. N. C. DAS