In 1989, the West Florida Regional Medical Center (WFRMC) hospital was offering traditional services to its patients, and this had made the hospital lose many customers as most of the latter were seeking care to other health facilities which were delivering quality services. However, in order to compete effectively with other health facilities, the hospital opted to implement total quality management program, which managed the hospital to realize its set goals and objectives.
WFRMC hospital opted to invest heavily in total quality management program due to numerous reasons. First the hospital documentation processes were poor and outdated (Mclaughlin, Johnson & SOllecito, 2012). In this documentation process, most nurses were not documenting the amount of drugs that they happen to administer to the patients or when they do document, they sometimes made errors in recording, and this contributed to high losses being incurred by the hospital. Moreover, some ancillary services such as the loose reports were not being compiled into the patients` medical records and this in most cases delayed the discharge of patients. Incorporation of total quality management was anticipated to enhance the documentation process in that hospital.
Another reason is the continuous training that total quality management program incorporates. The employees who are not producing maximally are equipped with knowledge and skills of resolving existing problems. For example, the heads of WFRMC hospital departments are furnished with ways of identifying problems in their departments that in the long run increases the quality of services. Customer satisfaction is also enhanced by TQM. The nurses are anticipated to deliver quality services to the patients, and this would lead to patients` satisfaction (Bhat, 2007). Satisfied customers are likely to come back later when they need the same services again, or direct another customer to that hospital, and this increases the returns.
Teamwork is another reason for investing in total quality management program. Employees are anticipated to respond to technical challenges as a team, and the probability of getting solutions are always high. TQM views teamwork as a more powerful and effective entities compared to an individual. In WFRMC hospital, teamwork would eliminate duplication of work, improve quality of services and improve productivity (Bhat, 2007).
First, the TQM program calls for piloting and evaluation of departmental functions in order to identify the possibility of existing problems that hinder the productivity and quality of the department. For example, the piloting and evaluation team identifies the failure of nurses to document the amount and costs of the drug administration in the medical records to the cause of hospital losses and delay of patient discharge. After problem identification, policies or guidelines for quality improvement are made, and this may involve team formation and quality responsibility (Mclaughlin, Johnson & SOllecito, 2012). Then, guidelines for communicating these quality improvements to the employees are reviewed in order to enhance their awareness.
The employees are then encouraged to provide their suggestions for quality improvement, where feasible suggestions are incorporated in the quality improvement policies. The employees are then trained to achieve the set quality improvement programs and after a specified duration, the outcomes are evaluated and recommendations for further improvement are made (Mclaughlin, Johnson & SOllecito, 2012).
Implementation of total quality management in WFRMC hospital has both strengths and weaknesses. Some of the strengths are that the quality of services is continuously improved through the identification and correction of the causes of quality problems, training of employees, innovation of improved working techniques among others (Mandal, 2011). For example, failure of some nurses to document patient`s drug administration is identified and corrected, new charting process is developed which reduces daily charting times, number of telephone calls requesting nurse reports are reduced, and the number of man hours spent in preparing the charts is reduced. In addition, Customer satisfaction is attained through the improved quality of services as ascertained by continuous research and interviews seeking to gather patients` responses concerning the value of services that they had received. TQM also builds the hospital reputation due to reduced defects, development and customer satisfaction.
However, TQM calls for a change of organizational culture that strives to achieve quality improvement. Change of organizational culture is challenging as it amalgamates and interrelated set of attitudes, values, goals, assumptions, roles, processes and communication practices, and this is received with resistance from some employees who consider it as a threat to their duties (Mandal, 2011). In this hospital, one nurse opted to resign after the implementation of TQM. Implementation of TQM program is expensive as it requires training costs, infrastructure modification costs and team development costs. Moreover, the program requires adequate planning, resources and time in order to succeed and thus taking prolonged periods before the results are realized. In this case, the realization of TQM results takes almost one year.
Corporate headquarters have the duty of mentoring the employees on the various ways of improving the quality of services. This mentorship is achieved through communicating the possible quality guidelines and protocols in their departments, which had been formulated after identifying an existing loophole that deters the quality of services being delivered. Moreover, the corporate headquarters is responsible in training the employees in areas that the latter faces challenges of understanding and delivering his or her delegated duties. In addition, the corporate headquarters have the duty of continuous monitoring and evaluating the employees` performance and if need be, provide recommendations for quality improvement (Mclaughlin, Johnson & SOllecito, 2012).
Consecutively, the headquarters are required to conduct research and interviews in order to identify customers` expectations. This helps in generating and delivering services that are parallel to the expectations of the customers. Additionally, they also have the duty of possible opportunities in the departments that require additional staffing (Mclaughlin, Johnson & SOllecito, 2012).
In order to measure the impacts of TQM program within WFRMC hospital, the hospital adopted several efforts. First, the hospital hired a consultant, who conducted an evaluation of the potential growth of obstetric services, the nature of the current services that were being offered by WFRMC hospital, customers` satisfaction and desires in order to identify areas that need further improvements (Mclaughlin, Johnson & SOllecito, 2012).
Consecutively, numerous conferences and meetings were being held by the nurses and the medical staffs in order to analyze and conclude on the observed variations in the hospital, and then make recommendations for improving quality and save production costs. For example, to manage obstetric patients at a low costs, six obstetricians met and suggested that, in order to control pain in these patients; two drug doses (one costs $10 and the other $75) can be administered (Mclaughlin, Johnson & SOllecito, 2012). However, they concluded to be using a cheaper one since the outcome of both drugs is the same. In addition, Continuous Quality Improvement teams were developed in an attempt of measuring the impacts of TQM programs.
Various efforts were employed by WFRMC hospital in order to enable TQM program to support technical programs in the hospital. First, the hospital management would re-delegate duties in some units, especially where the previous employee is suspected to be incompetent in undertaking and delivering the services that the administration targets to achieve. For example, Mrs. Cynthia Ayres, who was at first the director of cardiovascular and psychiatric services, was delegated and assigned to implement the transition of LDRP services (Mclaughlin, Johnson & SOllecito, 2012).
Moreover, staffing was also being employed in order to facilitate the implementation of TQM program. However, this was being applied at the point where the corporate headquarters identified an opportunity that requires additional employee (Mclaughlin, Johnson & SOllecito, 2012). Consecutively, identification of consumer needs was also employed in order to facilitate the TQM program to develop services that meet consumer needs.
In order to maintain continuous quality improvement, Mr. John Kausch should adopt mechanisms for reducing the variations in the implementation of TQM in various hospital departments. By the end of the first two years, the range of implementation is large, and this is not encouraging. To achieve this, Kausch should introduce periodic training of employees, which should be accompanied by sensitizing all employees the necessity of continuous quality improvement. Moreover, Mr. Kausch should incorporated ways of motivating employees such as giving some days off or rewarding them (Adams, Corrigan & Institute of Medicine in United States, 2003).
Moreover, in order to ensure continuous quality, Mr. Kausch should establish mechanisms of improving communication such as the use of internal and external organizational resources (Adams, Corrigan & Institute of Medicine in United States, 2003). Maintaining and improving these communication systems enhance partnership and funding possibilities in an organization.
Internal medicine residency programs are those which strive in taking care of psychologically unstable patients, who require continuous and minute-to-minute delivery of therapies in relation to the nature of disease processes. These programs require steady delivery of therapies through titrations and other micro-systems in order to achieve better results. If these programs are to be implemented in WFRMC hospital, the concepts of micro-systems should be considered for the purpose of maintaining the quality of services offered. Proactive processes should be incorporated in these hospital systems for the purpose of detecting, recognizing and solving problems that may arise, and thus increase their reliability and predictability. This minimizes or eliminates costs which may are associated with system errors, failures and poor outcomes and in the long run enhance the reputation of the hospital (Myers, Bellini & Morris et al. 2006).
Most anesthesiologists oppose the issues that raised by LDRP due to the possibility of congestion of the hospital rooms by patient`s family members, friends and relatives. The patients had proposed that the delivery of children should be conducted in one room, with the presence of the husbands in order for the patients to feel like the hospital services are being offered at their home settings. The physicians consider this as a hindrance to their routine delivery of quality services due to the increased number of individuals who are monitoring them. Moreover, the anesthesiologists think the presence of a high number of individuals observing their delivery of services would disrupt their decision-making process (Mclaughlin, Johnson & SOllecito, 2012).
Diagnostic- related group is a United States program of billing hospital or medical services by linking various diseases into groups, based on the required resources of care, and are organized by a diagnostic category. A dollar value is allocated to each group as a payment determinant of all individual cases in that group, without considering the expenses of the duration of hospitalization or care services offered to that individual. The purpose of diagnostic related groups is to encourage the health care organizations to cut the costs of services that they bestow to patients (Baker, 2002).
WFRMC hospital intended to make new families obstetric services to be more attractive in order to satisfy the patients` needs and thus increase the possibility of those patients to return to the same hospital for the same services. Moreover, Satisfied patients` have the likelihood of spreading the good reputation of the hospital and thus increase the chances of their friends coming to experience the same, hence increase the returns of the hospital (Mclaughlin, Johnson & SOllecito, 2012).
Adams K., Corrigan J., & Institute of Medicine (U.S.). (2003). Priority areas for national action: Transforming health care quality. Washington, D.C: National Academies Press.
Baker J., J., (2002). Medicare payment system for hospital inpatients: diagnosis related groups. Journal of Health Care Finance 28(3):1–13
Bhat K., S., (2007). Total quality management (text and cases, 4nd edition. Himalaya publishing, India.
Mandal S,. K,. (2011). Total quality management. New Delhi: Vikas Publishing House Pvt. Ltd.
Mclaughlin C., P., Johnson J., K., & SOllecito W., A., (2012). Implementing Continuous Quality Improvement In Health Care. A global casebook. United States of America.
Myers J., S., Bellini L., M., Morris J., B et al. (2006). Internal medicine and general surgery residents’ attitudes about the ACGME duty hour’s regulations: a multicenter study. Acad Med. 81:1052-1058.