Quality Hospitals Case Study Sample

Feigenbaum defines quality as an “excellent-driven” rather than a “defect-driven” process. However, such a definition will depend on the role of people defining it. According to Feigenbaum, there is no system of universally defining quality because some people view quality differently. For instance, some view quality as “fulfilling the customers’ needs” while others view it as “conformance to the standards or specifications set”. In the context of healthcare – particularly the case study – the physicians or doctors will have a slightly different viewpoint regarding quality in the hospital. The nurses too will have their own viewpoint while patients will tend to define quality based on the services rendered by the hospital and staff. Doctors – in their attempt to remain independent – will prefer to define quality as a process where employees are empowered to seek quality problems inherent in the hospital systems.
The doctors’ views, in this case, are based on their need to preserve the autonomy as well as be involved in major decision-making in the healthcare system. Employee empowerment is an integral part of Total Quality Management (TQM) philosophy where employees are given incentive on identifying quality problems inherent in a company’s system. In this case, the doctors will be empowered to make decisions relative to quality in their entire hospital services. As a result, they are considered crucial in the continuous improvement of the hospital services in an effort to achieve higher quality. Their views are highly valued, and most of their suggestions implemented. The hospital, however, will need to provide continuous and extensive training in quality measurement tools to the doctors and/or physicians so that they can perform this function in the hospital. The nurses, on the other hand, will tend to define quality based on the use of quality tools and equipment. In this scenario, Total Quality Management often places significant responsibilities on every worker. In order for the nurses to identify and rectify problems in quality, they must be given training that matches their role in the hospital set-up. They must also be trained on how to assess the quality through various quality control tools, interpret findings, and consequently correct problems identified. Most of their work will focus on preparation of patients’ files as well as providing nursing care to them. To rectify problems that may arise in preparing the files and in the provision of nursing care, the nurses must be given enough training that focuses on meeting their role in the production process. The patients’ definition of quality often reflects their view or perceptions to services rendered to them. Healthcare is a service and defining quality in such a context can be difficult; therefore, the patients will use their perceptions of such services rendered in defining overall quality. For instance, the reputation of a hospital may be in doubts but upon a patient experiencing a friendly staff, their definition of quality changes; they will refer to the services rendered as high quality. As such, the patients’ definition of quality will depend on the hospital’s response to customer needs, friendliness and courtesy of staff, and promptness in responding to challenges. Other major definitions of quality to the patient ill include the time taken for a patient to be seen by the doctor; and consistency – the degree of replicating the same service every time.
As Dr. Shewhart puts it, common cause variation is created by numerous factors that are always part of the production process. These factors act randomly and independent of each other. Their source is often traced to the materials, environment as well as the processes used. The presence of only common cause variation in the production process does not affect the stability of the entire system over time. In the case study scenario, environment will be critical in the preparation of a patient’s file for surgery. For instance, the environment (preparation rooms) may have poor lighting, dust and such other things that tend to make information entered in such files inaccurate or soiling of the files by the dust. Processes in the hospital will also determine the presence or absence of the common cause variation. For instance, poor filing designs and poor quality management of the filing system will serve to introduce such common cause variations. In order to address this issue, one would need to consider targeting the filing system in order to introduce an efficiently designed and managed filing system to eliminate inaccurate, incomplete and inconsistent information in the patient surgery files.
Dr. Shewhart further refers to assignable (or special) cause variations as those variations created by non-random factors or events resulting in an unexpected change in the output process. Often, the effects observed in these assignable cause variations are unpredictable as well as discontinuous. The presence of such variations in the production process makes the process output unstable and unpredictable over a long period of time. Therefore, in order to bring all processes into control, all the assignable cause variations must be detected and eliminated in entirety. In the context of the hospital case study, the special or assignable cause variations may be seen in the preparation of a patient’s surgery file by identifying such factors as workers and machines. Indeed, the above factors have the greatest influence on the assignable cause variations presence or absence. For instance, workers’ training, ability, and experience will be reflected in the manner in which information is entered in the patient’s file. On the other hand, faults in the patient’s file may be linked to machines involved in the process. A good example is pre-tests and previous observations done on the patient in preparation for surgery. The machines may bring such variations due to poor maintenance, calibration errors, the type and age of the machines. All these causes will usually lead to quality problems in the process output.
A number of Edwards Deming’s philosophical elements deviate from traditional norms of quality. As such, Deming has continuously been regarded as the “father of quality control”. Indeed, all of his 14 points are based on the idea of initiating a commitment to quality from the top management down to all employees in a company. Deming emphasizes that the upper management in a company must initiate a quality commitment and further provide a support system that seeks to propel the commitment. As he mentions, every process in this commitment should involve all the company’s employees as well as its suppliers. Traditionally, poor quality has been blamed on employees’ productivity, carelessness, and/or laziness. However, Deming pointed out that only 15 percent of quality problems are attributable to workers; the remainder (85 percent) is solely the responsibility of the company in terms of poor management, and failure of the processes and systems. Deming argued that it is the management’s responsibility to ensure that problems with systems and processes are corrected. In addition, the management is responsible for creation of a quality-promoting environment while ensuring that their workers achieve full potential. In the hospital case study context, it would be prudent to focus on initiating a comprehensive quality commitment from the top management downwards while also ensuring that every hospital employee achieves their full potential. To achieve this, it would mean assessing all the processes and systems in order to ensure that poor management is eliminated. It would not be sufficient to blame the workers on quality problems identified in the patients’ files since their contribution in this only accounts for 15 percent compared to the enormous 85 percent attributable to the hospital management.
Based on Juran’s definition of little q versus big Q, the hospital seems to be practicing the little q. This is ascertained by two major clues. First, and going by Juran’s definition of little q, the hospital makes continuous improvement to quality one project at a time. The recent assessment of the hospital’s surgery center is a good example of this. The second example of the presence of the little q in the hospital is the gradual nature of the improvement processes. In this case, the hospital is not concerned on how fast or slow the improvement is happening but on whether there is improvement after all has been done. In full satisfaction of Juran’s argument, the hospital takes actions aimed at improving processes in service delivery while spiraling up the performance and success of the company. The spiraling up of the performance and success in the hospital means that improvements start at the workers’ level moving all the way to the management. For every completed project, there is a gradual spiraling up on the hospital’s quality spiral ladder. Additionally, every single improvement adds onto the previous achievement in order to take the hospital to greater heights and achievement levels. In order for the hospital to implement the big Q, it would need to leverage on the corrective as well precautionary action processes. This would serve in the creation of dramatic transformations in its service delivery processes that will consequently have significant impacts at the bottom line.
Phillip B. Crosby’s definition of quality is an ultimate drive to the process of quality improvement in the hospital. According to Crosby, things should be “done right the first time” in order to eliminate any hidden defects in the process output. The notion that quality has an economics of cost is indeed one of Crosby’s five erroneous assumptions that he argued people referred to. In a rejoinder, Crosby says that no amount of deficiencies ought to be considered as acceptable in the quality improvement process. As such, he rightfully ridicules the notion that minor defects are a normal part of the process output due to the imperfect state of workers and systems. Quality is free and there exist no economics of quality in the improvement process. Indeed, efforts focused on the improvement of quality achieve fruition more than expected because the costs involved in the process are prevented. Such costs include prevention costs (costs of preparing and implementing a quality plan) and appraisal costs – costs of testing, evaluating, and inspecting quality. As such, the idea that there is economics of quality is ill-founded.