Quality Management in Healthcare Services

Unit 2

Unit 2

Quality Concepts and Quality Philosophies

Structure:
2.1 Introduction
Objectives
2.2 Quality Concepts
Maxwells concepts of quality
Donabedians quality concept of structure-process-outcome model
Standards and standard-setting
2.3 Quality Philosophies
W. Edwards Deming philosophy of quality
2.4 Application of Quality Concepts to the Healthcare Industry
Principles essential to promote quality in healthcare
The business significance of quality in healthcare
2.5 Summary
2.6 Glossary
2.7 Terminal Questions
2.8 Answers
2.9 Case-Let

2.1 Introduction
The previous unit dealt with the meaning and definition of quality. We have
also dealt with need for quality and pioneers of quality in healthcare service.
In this unit, we will discuss the concepts and philosophies of quality in
healthcare services. It discusses the application of quality concepts and
philosophies to the healthcare industry.
Objectives:
After studying this unit, you should be able to:
comprehend the concepts of quality
explain quality philosophies
discuss the application of quality concepts and philosophies to the
healthcare industry

2.2 Quality Concepts

Quality in healthcare is a broad conceptual framework which includes every
aspect of performance and service of healthcare industry. Quality concepts
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are very useful in understanding and solving the issues related to healthcare
services. A well-defined concept of quality helps in proper functioning of a
healthcare system leading to effective service to the patients.
Many experts have used different models to explain the concept of quality in
healthcare services. The most important models are - Maxwells concepts of
quality and Donabedians structure-process-outcome model.
2.2.1 Maxwells concepts of quality
Maxwell (1984) suggests a six dimensional quality model of healthcare
services. His quality model is used to assess the provision of quality
services to patients in healthcare. They are:
1. Access This concept is about the accessibility to service for patients
in terms of using infrastructure, paperwork, treatment, language, and
social assistance. Can people get this treatment/service when they
need it? Are there any identifiable barriers to service? for example,
distance, inability to pay, waiting lists, and waiting times -or
straightforward breakdowns in supply.
2. Equity Patients must have healthcare services available to them
irrespective of their social, cultural or racial background. Is this patient
or group of patients being fairly treated relative to others? Are there any
identifiable failings in equity - for example, are some people being dealt
with less favourably or less appropriately in their own eyes than others?
3. Relevance to need The healthcare must meet the needs of the
whole community. There must be no deficiency in provision of services
to the needs of the community. Is the overall pattern and balance of
services the best that could be achieved, taking account of the needs
and wants of the population as a whole? For example, a healthcare
must have good physicians, lab technicians, qualified nurses, biomedical equipments and other facilities to provide the best services to
the community.
4. Social acceptability Use of services, in terms of social and religious
values, must be acceptable to the community. Care and treatment must
meet the expectation and satisfaction of patients. How humanely and
considerately is this treatment/service delivered? What does the patient
think of it? What would/does an observant third party think of it? What
is the setting like? Are privacy and confidentiality safeguarded? For
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example, a clinical staff of a healthcare must respond immediately to

an emergency patient and must provide the services that are
acceptable to his/her family members.
5. Efficiency Cost-effective services to the patients must be provided
within the resources available. Healthcare organisations must be
efficient to provide service to the poor patients at a cost which is
comparable to other nearest health care facility. Is the output
maximised for a given input or is the input minimised for a given level of
output? How does the unit cost compare with the unit cost elsewhere
for the same treatment/service?
6. Effectiveness Efficiency is the ability of a healthcare unit to provide
cost-effective services and effectiveness is the result or outcome of
healthcare services to patients. Provision of healthcare must result in
beneficial patient outcomes. Effectiveness is also about healthcare
benefits for the population that is being served. Inappropriate care and
harmful treatments are considered as ineffective. Are there any
decrease in the average length of stay at the hospital and an increase
in the output?
2.2.2 Donabedians quality concept of structure-process-outcome
model
The Donabedian model (1970) is used to examine the quality of healthcare.
It is also used to examine the use of healthcare services and the outcomes
of delivery of services. There are three specific sets of criteria for quality and
standards. They are:

Structure - This factor discusses about the structure of a healthcare

delivery system in terms of human resources, material resources and
organisation. The model examines the access to healthcare for patients
and evaluates the service provider and organisation that deliver the
service. For example, a healthcare organisation needs staff with
appropriate skills and qualifications in sufficient numbers to reach certain
service standards. Other resources involve equipment, buildings, and
infrastructure. The structure relates to the environment, the resources
and the documentation guiding staff that are necessary for the delivery of
healthcare service.

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Process Process relates to what is actually performed to achieve

quality in healthcare services. The model examines the amount of care
delivered to patients and the outcomes of the care. For example, the
model examines and evaluates the process of providing care and service
to patients to improve their health status. A lab technician must follow
proper processes and use appropriate equipments while testing patients
blood sample in the lab.

Outcome This factor determines the extent to which the delivered care
results in an improvement in the patients social and psychological
functioning. Patient satisfaction is considered as an important measure of
outcome. The outcome of care helps to evaluate the impact of care on a
group or individuals. This results in patient satisfaction with care and
service, improved health status of patients, and increase in patients flow.
Figure 2.1 depicts the Donabedians quality concept of structure-processoutcome model.

Figure 2.1: The Donabedians Structure-Process-Outcome Model

2.2.3 Standards and standard-setting

Mason (1994) describes standard as a valid definition of the quality of
healthcare. Every service of a healthcare that is delivered according to a
standard will result in positive outcomes for a patient. A standard is valid
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when the staff of a healthcare organisation understands the meaning of the

standard and delivers service according to the standards set. To be precise,
a standard must be a level of performance that is agreed in advance and it
must be measurable. For example, a healthcare must fix the standard
waiting time for patients and must follow it to achieve patient satisfaction. It
must not make patients to wait for a long time to meet the physicians. A
healthcare must have realistic and achievable standards in relation to the
available resources. When a standard is not measurable, it is divided into
parts that are measurable. These measurable parts are called criteria and
give the actual measurements of quality.
Standard-setting is important to audit practice of professionals. Standardsetting is alone sufficient to achieve, maintain and evaluate quality.
Standard-setting consists of identifying goals and values for the service
delivered to patients in a healthcare. It encourages team-work in delivering
service and leads to achieve quality service standards.
Self Assessment Questions
1. Patients must have healthcare services available to them irrespective
of their social, _______ and _________ background.
2. Patients must be allowed to meet the same physician for the continuity
of the service. (True/False)
3. Healthcare organisations must provide _________ services to patients
within the resources available to them.
4. The ________ model is used to examine quality of healthcare.

2.3 Quality Philosophies

A quality philosophy accompanies the definition of quality and a set of
guidelines for quality management of a healthcare organisation. Healthcare
services must have a patient- centric philosophy which has a definite vision,
mission, and values in the task of delivering services to patients. Healthcare
services must function according to its philosophies and must aim to provide
service in a manner that respects patient rights. It is also important for
healthcare services to maintain high standards of service through a
commitment of consistent service delivery and quality measures.

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Several individuals have made significant contributions to quality

philosophies and improvement. Let us discuss the philosophies of W.
Edwards Deming on quality.
2.3.1 W. Edwards Deming philosophy of quality
W. Edwards Deming, the best-known quality expert in the world, contributed
significant ideas in post-war industrial revolution of Japan. Later his ideas
and philosophies of quality were adapted in industries and healthcare
organisations in United States and other parts of the world. Deming believed
that quality is responsible for the success of a service organisation. The
following Deming philosophy of quality is applicable to both small and large
organisations, and to healthcare as well as manufacturing industry. His
philosophies can also be applied to a division within a company. The
following are the14 points of Demings philosophy that helps to improve
quality services to patients in a healthcare organisation:
Create constancy of purpose for the improvement of delivery of
service The point focuses on the need for continual improvement of
services to the community, allocating resources for long term goals
rather than only short term goals, a plan to being competitive and staying
in business and providing more jobs. The top management should create
a mission statement. This must be made known to all in the organisation.
Adopt the new philosophy - Healthcare management of an organisation
must know the needs of the modern era and awaken to the challenge.
Poor facilities, use of defective bio-medical equipments or bad service
are not acceptable.
Adopt a value based philosophy to deliver services A healthcare
must never make commonly accepted levels of mistakes in providing
services to patients. For example, a healthcare must never use defective
methods of treatment procedures to treat patients. It must provide value
added quality services to patients to achieve patient satisfaction.
Cease dependence on mass inspection A healthcare organisation
must establish quality in services to eliminate the need for inspection. For
example, statistical data of patients who receive service in a healthcare
organisation helps in improving quality of care. But a healthcare must
avoid depending on its inspection team to ensure quality services to
patients. It must provide result oriented quality services to each patient
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following the right process. So there will be no need for inspecting the
services provided to a larger group of patients.
End the practice of awarding business on the basis of price Price
must not be the only criteria when empanelling service providers. The
healthcare organisation must imbibe a culture of mutually beneficial
supplier relationship.
Improve the system of service constantly and forever The
improvement of service is an ongoing process. The Deming cycle
includes a four-step process of plan, do, check and act. At the plan
stage, the opportunities for improvement are identified. The plan is
implemented and the results of the test are verified at the check stage.
The results are measured, analysed and improved in the act stage
through the continuous improvement life cycle process.
Institute training On-the-job training must be provided for all the
clinical and non-clinical staff in ensuring competency at all levels. They
must be encouraged to implement the knowledge developed through
training. For example, the correct use of bio-medical equipments, proper
billing practices and so on.
Adopt and institute leadership for supervising staff - The aim of
supervision must be to help the staff to do a better job. Supervision must
create an environment where the clinical and non-clinical staffs take
leadership roles in accomplishing their work. Management must ensure
corrective and preventive actions are taken in a timely manner for all
conditions detrimental to health care service quality.
Drive out fear The top management must encourage an effective
communication process with all the stakeholders in the organisation to
drive out fear across the organisation, resulting in productive work and a
satisfied customer.
Break down barriers between staff and patients A healthcare
organisation must treat its patients with equity, irrespective of their social,
cultural and racial background. The flow of information and work
between departments must be seamless. They must not work in
isolation. This will create barriers between staff and patients.
Eliminate slogans, exhortations and targets for staff The
management must eliminate the use of slogans without providing
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methods. The service related to targets without proper methods will

result in low delivery of service and patient dissatisfaction. The staff must
provide the service focusing on the needs of patients.
Eliminate numerical quotas Eliminate work standards that describe
numerical goals in terms of treatment rates and incentive pay in a
healthcare. The medical staff must first respond to the patient needs and
must provide the treatment within the available resources. The
organisation must provide necessary resources and effective leadership
to deliver consistently good service quality.
Satisfaction in the delivery of service Quality is achieved in a
healthcare organisation when all patients are satisfied and motivated.
Management must create an environment where the patients feel free to
ask and clear their doubts.
Encourage education and self-improvement for patients A
healthcare organisation must educate the patients about the facilities,
treatments and other health disciplines that it can provide. Empower staff
to fix the problems in the processes, for they know the problems of their
processes and given an opportunity, will fix them. Develop a habit of
defect prevention as part of everyone's job.
Take actions to accomplish the transformation The transformation
is everybodys job. The top management commitment drives the
improvement in transforming the organisation through a continual
improvement process. In support of the quality philosophy a healthcare
organisation must provide patient-centred and patients family-centred
services that focus on the patients physiological, safety, psychological,
and self-esteem needs. The organisation must also provide healthcare
education to the patient, patients family and community.
A good healthcare organisation must adhere to its quality philosophies for a
patients well-being and for successful business. Some of them are:
To provide information regarding the services to patient and patient
families.
To provide information regarding the quality assurance policies and
operations to other healthcare organisations.

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To provide information regarding the quality assurance practices to

individuals, agencies, and institutions involved with education and
research.
To implement and reflect the mission in the delivery of healthcare
services.
To document the history of the patient on his first visit and also on other
visits.
Activity 1:
Consider that you are the manager of a hospital which is providing
medical services to the patients. Identify the quality concepts which you
think are necessary for your hospital to provide high quality services to
the patients.
(Hint: Refer to section 2.2 Quality Concepts.)

Self Assessment Questions

5. Healthcare organisations must have a ________ philosophy that
values respect for patients dignity and privacy.
6. Healthcare organisations must take necessary actions to ________
patients into healthy human beings.
7. A healthcare must ________ to its quality philosophies for a patients
well-being and for successful business.
8. It is not necessary to document the history on first and regular visits of
the patients. (True/False)

2.4 Application of Quality Concepts to the Healthcare Industry

Improving quality is a challenge for healthcare organisations as most of
them have failed to provide quality of services delivered to patients. The
definitions of quality concepts are not sufficient to accomplish continuous
improvement in healthcare organisations. Application of quality concepts in
healthcare organisations consists of the degree to which healthcare service
for individuals and population has met the following:
Must increase the desired health outcomes (quality principles).
Must be consistent with present professional knowledge (practitioner
skill).
Must meet the expectations of consumers (the marketplace).
Principles essential to promote quality in healthcare
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The healthcare services organisation must ensure to deliver quality services

to patients. It is necessary to ensure the associated service provider for the
patients to achieve the desired health outcomes and patient satisfaction.
The main task of a healthcare organisation is to implement performance
monitoring system which provides safeguards against:
Under-utilisation of services.
Unnecessary diagnostic and treatment procedures.
Irrational use of drugs to patients.
Use of fake or unregistered drugs.
Bad response of clinical or non-clinical staff to patients needs.
Successful healthcare organisations, such as hospitals, physicians offices,
pharmacies, nursing homes or ambulatory centers must understand, identify
and implement the following essential principles into practice:
Leadership and change
Measurement
Reliability
Practitioner skills
Marketplace
Leadership and change
Leadership is the ability to influence behaviour. The reason for changing
behaviour is to reach specific goals within an organisation. Coping with
change is an essential focus of an effective leader. Often, there is a
challenge for a leader in bringing in competent people throughout the
organisation to do challenging jobs.
Clinical and non-clinical staff in healthcare organisations must be resistant
to change. The rapid rate of change in healthcare organisations leads to a
constant update of skill for all healthcare administrators, medical staffs and
non-clinical staffs. An important role of leadership is to set organisational
goals through communication and to guide the organisation to accomplish
the needed change in service.
Kotter explains eight stages to cope up with change. His eight stages are
used to make changes in the delivery of services. They are:
1. Create a sense of urgency in the delivery of service.
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2.
3.
4.
5.
6.
7.
8.

Unit 2

Build the guiding coalition with patients and family members.

State a vision and strategy for the delivery of service.
Communicate the change vision to the staff and patients.
Implement broad-based action while delivering the service.
Adopt short-term wins to reach patient expectations and satisfaction.
Review gains and produce more change in the service.
Make new approaches in the method of service.

The above mentioned elements help a healthcare service organisation to

have process improvement, risk awareness, communication and innovation
to achieve the levels of service and clinical performance.
Measurement
Quality in healthcare services is measured in terms of outcome (a
healthcare outcome is the change in health status of the patient that is a
direct result of clinical care) or process (what providers do to and for
patients). An outcome measurement is a powerful tool in cardiovascular
surgery and hospital-acquired infections.
Measurement of process is a commonly used method than changes patient
health status. Measurement of process is under great control of clinical care
provider and needs a short time frame for results. It also directly modifies
improvement and may not require statistical adjustment for severity of
illness. For example, evidence based communication with a patient is
performed appropriately in time. In a patient with typhoid, either the
antibiotic was given on time or it was not. In a patient with fever, either a
paracetamol was given or it was not. These processes are examples of the
nationally reported core measures reported on a quarterly basis to certified
statutory government agencies such as Joint Commission International (JCI)
and the Centers for Medicare and Medicaid Services (CMS). The quality
indicators are a significant part of hospital and physician assessment. For
example, patients can decide the doctor and hospital with the available
costs on the core measures of hospital and physician assessment.
Healthcare service providers are less certain about the value of
measurement. But quality measures are reportable to the public in the form
of core measures. These measures have a tremendous impact on how
services are offered to patients. The CMS helps to create a change in the
acceptance of the process defined approach to quality. The publicly
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available core measures are a set of processes that improve the healthcare
services provided to patients. These measures have improved clinical
outcomes in some of the highest-volume illnesses, namely pneumonia,
congestive heart failure and surgical-site infection. New measures in
surgical care improvement, childhood asthma and behavioural health are
also in progress. The measures are based on extensive clinical research
that focuses on improving patient outcomes. The core measures create the
foundation for evidence-based metrics that meet the definition of care in
some prevalent medical conditions.
Reliability
Every identified problem in a healthcare organisation is the problem of a
reliable process. In evaluating highly reliable service organisations, five
principles are found to be universal. They are command and control, risk
appreciation, a specific quality component of the industry, metrics driving
management and reward.
Command and control Healthcare services must be delivered
according to the standards agreed in advance in an organisation. There
must be a control over the quality of services delivered to patients to
ensure the improvement and high quality services.
Risk appreciation - To have the knowledge about risk in delivery of
service is important. It is also more important to take necessary steps to
minimise the risks in healthcare organisations.
Quality - Policies and procedures for promoting high-quality services are
essential to give reliable services to patients.
Metrics - A system of ongoing checks to monitor hazardous conditions
is essential for accountability and also to keep a track on number of
patients who receives the healthcare service.
Reward - The clinical and non-clinical staff must be given a warning or
punishment for behaving badly with patients. For example, inappropriate
care for patients in hospitals. In these situations, patients must be given
expected social compensation and the staff must be given a warning to
correct his/her behaviour. However, those who achieve patient
satisfaction must be recognised and rewarded.
Variability is one of the challenges in creating reliable processes. Healthcare
processes and outcomes are variably measured and demonstrated. The use
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of easily understandable visual presentations allow physicians to compare

their performance against what they may or may not agree is a best
practice. This helps to deliver reliable services to patients in healthcare
organisations.
Practitioner skills
High quality services in healthcare can be achieved in a reliable way and
doing the right things right. To do the right thing; physicians, nurses and all
healthcare providers must make the right decision about appropriateness of
services and care for each patient. To do it right requires skill, judgment and
timeliness of performance.
Threats to quality are characterised into three broad areas that affect
practitioners:
Overuse (giving treatment of no value to patients)
Under use (failure in giving needed treatment to patients)
Misuse (making errors and defects in treatment)
The physicians and practitioners make treatment decisions in a way that
appropriately utilises resources without overuse, under use or misuse. This
is difficult to control because of variability in physician treatment methods.
Evidence-based medicine has helped in decision making to reduce this
variability. Relying on evidence based treatment, practitioners can decide on
the appropriateness of services, care, and execution of the patients care
appropriately.
Both overuse and under use limit the practitioners decision making ability.
Both areas focus on the competence of the practitioners and their ability to
utilise resources appropriately. A practitioner must ask the following
questions and evaluate himself/herself to avoid the overuse or under use of
service:

Do they utilise resources appropriately?

Are they ordering too many treatment methods and tests?

Are they ordering too few treatment methods and tests?

Is the treatment appropriate and consistent with patients risk benefit

calculus?
When a service provider decides the treatment methods, the quality falls on
the performance of the individuals providing the service and care to the
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patient, and the system in which they work. In the treatment phase of the
care cycle, the service provider must have processes and practices in place
to ensure the treatment methods are completed and there is no misuse.
When errors and defects occur, quality is sub-optimised and patient safety is
at risk. So the service providers have to provide services to the patients
carefully and appropriately.
Marketplace
The marketplace has a great effect in motivating healthcare quality services
and it is essential to understand the role of quality of care in the current
environment of healthcare services. Public transparency, the promise of
improved payment and patient flow to the healthcare organisations,
improves quality metrics. The value of quality and efficiency of service
providers to deliver services excels in performance and results in more
patient flow to the organisation. Thereby, improves the business of the
organisation.
Healthcare involves the management of three main principles: cost, volume
and revenue. A healthcare organisation must understand the role of quality
in the market as it is fundamental to the environment in which it operates.
Quality is an important component in the basic business model of the
healthcare, the financial management of the healthcare, and the public
opinion driving decisions for treatment plans and treatment locations.
A key element of the economic model that quality must help and improve at
facilities is volume. Service providers and treatment facilities are
consistently judged on the quality of service they are providing. Although
some Service providers are able to thrive because of their technical
proficiency, this results in patients return and also refer their friends based
on the quality experiences they have had. If a patient has a bad experience
and receives the wrong drug at a facility (a misuse) or determines a
physician not ordering for a test with another physician (under use), the
patient may be less likely to seek care at that facility or from that physician
in the future. Additionally, patients will inform their friends about the bad
experience they had. Although opportunities for service recovery exist,
many patients are not returning to physicians and hospitals that provide
poor quality of service.

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Self Assessment Questions

9. Healthcare organisations must have __________ system to provide
patients safeguard against under use of facilities, irrational use of
drugs, and unnecessary diagnosis and treatment process.
10. Healthcare organisations must be efficient to cope up with changes and
must be resistant to change. (True/False)
11. Quality in healthcare organisations is measured in terms of
__________ or ___________.
12. The core measures create the foundation for evidence-based _______
that define the quality in healthcare organisations.
2.4.1 The business significance of quality in healthcare
Healthcare organisations have a difficult time in demonstrating the business
case for quality as there is a complexity of services and difficulty in capturing
the real fixed and variable costs of caring for patients. Better quality results
in less rework, less mistakes and delays, and a better use of time. By
improving quality, the healthcare organisations capture the market with
better quality and lower price and can innovate in the business and clinical
practice of medicine, and also provide more jobs to the society.
The difficulty in demonstrating the business case in healthcare organisations
is the result of lack of high quality healthcare services that fails to trigger the
results. Healthcare lags significantly behind many industries in terms of
errors and the ability to capture the measures that permit maximal
management of the complex healthcare process. The ability to provide
timely and detailed measurement in healthcare is of personnel intensive
because of insufficient real-time data. For example, a clinical staff in
healthcare manually collecting the patient data without using the advanced
system is an instance of insufficient real-time data. Healthcare organisations
obtain and use only a small fraction of the information necessary for
maximising the management of high-quality service.
A patient may think twice before taking the treatment in a healthcare
organisation. Many questions arise in his/her mind, such as, what is the cost
of quality? Does it raise the price of goods and services? These questions
are not easy to answer. But quality and costs are measurable. In a
healthcare, the failure to anticipate/ prevent serious complications, such as
a hospital-acquired infection may cost the patient his or her life or thousands
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of rupees in treatment. Avoidable surgical complication may prolong

hospitalisation, result in a prolonged disability or death, and cause great
expense and repeated procedures.
Healthcare organisations, however, are reluctant to enforce improvements
in better quality and so they fail to get better payment or improved
profitability. Now-a-days, the state governments are demanding a costeffective, safe, and patient-centered service as the public have doubts in
rising healthcare service costs and increasing healthcare plans of different
insurance companies Both physicians and hospitals are assessed with a
combination of quality and efficiency (cost) measures, and these
measurements are used to include or exclude both hospitals and physicians
from healthcare plans and services.
The current business significance of quality in healthcare is straightforward.
Access to the patient (both by volume and payment level) is determined
through demonstrating high quality and cost efficiency. A clear
understanding of the history and development of the concept of quality
patient service and the ability to understand, identify and utilise the key
quality principles will help to create successful healthcare organisations.

Activity: 2
Consider that you are working in the business development department
of a hospital. Identify the key principles and factors necessary to
improve the brand business and to increase the patient flow of your
hospital.
(Hint: Refer to section 2.4.2 Business significance of quality in
healthcare.)
Self Assessment Questions
13. Healthcare organisations have a difficult time in demonstrating the
business case for quality. (True/False)
14. By improving quality, the healthcare organisations capture the market
with better _____ and _______.
15. Serious doubts about the long-term __________ and rising
____________ costs are driving health plans in the current healthcare
business.
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16. Access to the patient (both by volume and payment level) is

determined through demonstrating high quality and cost efficiency.
(True/False)

2.5 Summary
Quality concepts and philosophies can be summarised as follows:

Quality in healthcare is a broad conceptual framework.

A well-defined concept of quality helps a health system to function well

and to provide good services to the patients.

Maxwells concepts of quality explains the key six dimensions of quality

to be followed in the delivery of service in healthcare organisations and
Donabedians structure-process-outcome model explains how the model
functions and leads to patient and practitioner satisfaction.

Healthcare organisations must have a patient-centered quality

philosophy that values respect for patients dignity and choice. W.
Edwards Deming philosophy of quality explains 14 points for the
success of a healthcare service organisation.

Application of quality concepts to the healthcare industry is dependent

on the key principles essential to promote quality.

The five main key principles explain the need to take leadership and
change to the situation, need to measure quality on the basis of national
statutory agencies, need to deliver a reliable service, need to develop
skills of the service provider or practitioner and need to improve
business in terms of providing high quality service and cost-effective
service to the patients.

The business significance of quality in healthcare shows how high

quality service helps in driving the volumes, revenue and success to a
healthcare organisation.

2.6 Glossary
Clinical staff:

It is a term used in hospitals for doctors, surgeons, nurses

and for those who are involved in the medical treatment.

Non-clinical
staff:

It is a term used in hospitals for lab technicians and

administrative people.

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Reliability:

It is a consistent performance or a result that can be

depended upon with confident certainty.

Sub-optimised:

It is a situation where a process, procedure, or system

fails or yields less than the best possible outcome or
results due to lack of best possible delivery of different
components, elements, or persons in organisations.

Metrics:

It is a statistical data of figures and numbers of patients

flow or service delivery in healthcare organisations
collected for evaluation.

2.7 Terminal Questions

1.
2.
3.
4.
5.

Describe Maxwells concepts of quality.

Discuss the Donabedians structure-process-outcome model.
Explain quality philosophies of W. Edwards Deming.
Elaborate the principles essential to promote quality in healthcare.
Discuss the business significance of quality in healthcare.

2.8 Answers
Self Assessment Questions
1. Cultural, and racial
2. True
3. Cost-effective
4. Donabedian
5. Patient-centred
6. Transform
7. Adhere
8. False
9. Performance monitoring
10. True
11. Outcome or process
12. Metrics
13. True
14. Quality and lower price
15. Sustainability and healthcare service
16. True

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Terminal Questions
1. Maxwell suggests a six dimensional quality model of healthcare
services. Refer to section 2.2.1 for the same.
2. The Donabedian structure-process-outcome model examines the
quality of healthcare. Refer to section 2.2.2 for the same.
3. The 14 points of Deming explains the quality philosophy. Refer section
to 2.3.1 for the same.
4. The five principles are very important to promote the quality of
healthcare. Refer to section 2.4.1 for the same.
5. Healthcare have has a difficult time in documenting business case for
the quality services. Refer to section 2.4.2 for the same.

2.9 Case-Let
Application of Quality Concepts and Philosophies
Pooja is the HR manager of The New Alpha Hospital. When she joined
the hospital, there were many issues related to quality in the delivery of
services in the hospital. Many patients who received the services from
the hospital were not happy and they complained about the services
delivered in the hospital. Regular patients started visiting other hospitals.
Pooja with her assistants determined the errors and defects in the area of
delivery of service to the patients. The errors and defects found, such as
increased waiting hours to see the doctor, inconsistency in test results by
lab technicians, unavailability of drinking water, bad linen management
and many more. She realised that most of the complaints or deficiency in
services were found in the non-medical staff service. She categorised the
non-conformities into men, machine and methods. She called all the
members of non-medical staff for a meeting and discussed the issues
with them. With the help of her assistants, she adopted quality concepts
and philosophies to help the non-medical staff to function well. She asked
lab technicians to use proper bio-medical equipments for a particular lab
test, linen management people to use washing machines and buy more
linen, housekeeping people to clean the toilets thrice a day and to place a
water cooler near the receptionist counter, and also recruited a
receptionist for the front office to respond immediately to the patients.
After two months, Pooja found the increase in patient flow to the hospital
and also the business of the hospital improved. She also introduced a
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Quality Management in Healthcare Services

Unit 2

performance monitoring system for quality maintenance and to check the

patient satisfaction level.
Discussion Questions
1. What are the non-conformities found in the delivery of service to the
patients? (Hint: Refer section 2.2 Quality concepts)
2. What were the steps taken to overcome the non-conformities in the
delivery of service? (Hint: Refer section 2.2 Quality concepts)
Reference
Brooker, C. and Nicol, M., Nursing Adults The Practice of Caring,
(2003), Philadelphia, USA, Musby Publications.
Graham, N. O., (1995), Quality in Health Care: Theory, Application and
Evolution, First edition, USA, Aspen Publications.
E-Reference
http://www.allbusiness.com/company-activities-management/operationsquality-control/10558838-1.html
http://www.khaledhassanein.ca/wp-content/uploads/2007/04/J7.pdf

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