Total Quality Management in Healthcare Organizations

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Total Quality Management in Healthcare Organizations

Healthcare Organization and Management · Chapter 4: Organizational Behavior and Leadership Theory in HealthcareSection 4.2 · lesson 20 of 1058 min · free with a free account

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Earn 3 college credits for Healthcare Organization and ManagementRecommended for credit by NCCRS · Health 302 · self-paced · one payment, lifetime access
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In this lesson

Total quality management principles and why healthcare TQM efforts fail.

  • Define total quality management and trace its origins
  • Explain the eight TQM principles and the meaning of customer in health care
  • Contrast a process response with a blame response to failure
  • Identify the three patterns that cause TQM efforts to fail

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Transcript

Everything said in the video, section by section (1,018 words). Read along, or search it.

Opening Question

A Lab Pilot With a Cross-Department Problem

Larkfield's lab director is asked to try total quality management, but only inside her own department, as a low-risk pilot. Her biggest quality problem, though, isn't inside the lab. It's the gap between a result being ready and a clinician acting on it. That gap runs through three other departments. Can quality management work inside one department's walls?

Definition

Quality Made by the Whole Organization

Total quality management, or TQM, is a philosophy: quality is produced by the whole organization, continuously, not inspected in at the end by one department. The word total does the work. Quality is everyone's job, it covers every process, and it's pursued permanently, not in campaigns. It grew from manufacturing. W. Edwards Deming lectured Japanese engineers in 1950, and Joseph Juran also shaped postwar Japanese practice. It entered health care in the late 1980s. Its ideas assume repeatable, measurable processes, so how far they fit clinical work is a fair argument, but no excuse to exempt it.

Eight Principles

From Customer Focus to Communication

TQM is usually summed up in eight principles. Customer focus: quality is defined by the people served. Total employee involvement: everyone improves the work, with the authority to do it. Process orientation: results come from processes, so change the process, don't exhort the people. Integrated system: functions connect, so improving one department can worsen the whole. Strategic and systematic: quality belongs in the strategy, not beside it. Continual improvement: small and permanent, not episodic. Fact-based decisions: data on how the process really behaves, not impressions or seniority. And communication: information flows every way, including up from the front line.

Customer Focus

Patients, Payers, Referrers, and Internal Customers

Customer focus fits health care least comfortably. Patients often don't choose, don't pay directly, and can't judge the technical quality of their care. So who's the customer? The patient, who can judge access, communication, dignity, and waiting. The payer, who cares about cost and documentation. The referring clinician, who decides where patients go. And the internal customer: the next step in the process, like the unit receiving a patient from the ED. That makes every handoff somebody's job. The patient's interest comes first. The danger is silent substitution: finding the patient's view hard to measure, and quietly optimizing for whichever customer is easiest to please.

Process Orientation

Fix the Process, Not the Person

Process orientation is the most consequential principle, because it changes what happens after a failure. Its claim is empirical: most variation in results comes from the process, not the people. A blame response asks who failed. The answer is usually correct and rarely useful, because the next person in that spot will fail the same way. A process response asks how the work was arranged so this failure was possible. That answer changes the odds of it happening again. Two cautions. Accountability doesn't vanish; it's assigned after the conditions are understood. And process work is slower and costlier, which is why organizations slide back to blame under pressure.

Quick Check

A Lost Specimen and One Courier's Name

Quick check. At another hospital, a lab specimen goes missing between two departments. The investigation ends with one courier's name, and a memo reminding all couriers to be careful. Which principle is missing? Pause, and decide. Process orientation. A name and a reminder change nothing about how specimens move between departments, so the next courier faces the same gap. Continual improvement is tempting, since nothing improves. But the root absence is that nobody examined the process at all.

Manager Demands

Leaders Must Move First

TQM demands more of managers than they expect. Visible commitment: senior leaders take part, rather than sponsoring from a distance. Protected time, because improvement piled on a full load stops when the load rises. Tolerance for reported failure: the reaction to the first bad-news report sets the volume of the rest. And changing their own decisions when the data disagrees. Fact-based decisions bind managers before staff. Staff, in turn, must participate, record accurately even when it's unflattering, and speak up. But each depends on the manager's side first. The organization moves first.

Failure Patterns

Delegation, No Measurement, and Reversion

Three patterns sink most TQM efforts. First, delegation to a department: a quality office gets the program, but the principles require operating managers to behave differently. Its main output becomes reports. Second, absence of measurement: no baseline, no measure of the actual claim, no balancing measure. Then every project succeeds, and the organization loses the ability to tell what works. Third, reversion under pressure: blame returns, protected time goes first, and consultation is suspended. That's the most damaging, because it teaches staff the philosophy was never real.

Quick Check

Praised Handoffs With No Baseline

Quick check. A hospital's new bedside handoff program is praised by every unit manager. The only evidence is a survey asking staff whether they feel handoffs improved. Which failure pattern is this? Pause, and decide. Absence of measurement. Without a baseline or a measured change, any program can claim success, so praise alone is a warning sign. Delegation is tempting if a quality office ran it. But the defining clue here is that nobody measured handoffs before and after.

Philosophy and Methods

Beliefs Need Tools, Tools Need Beliefs

TQM supplies the beliefs. Later in this course, improvement methods supply the tools: cycles, measures, and analysis. The two fail independently. Methods without the philosophy give skilled projects in an organization that punishes the reporting they need, and they stop when the team disbands. The philosophy without methods gives goodwill, and no way to tell what improved. The usual error is buying methods, which can be purchased, and expecting the philosophy, which needs leaders to change.

Case Resolution

Redesigning the Pilot Across a Pathway

Back to the lab director. She keeps the pilot but changes its shape. It runs on one pathway across the lab and the three other departments, with their heads taking part. She asks for an exception to the usual one-on-one counseling after reported problems, and for eight protected hours every two weeks, for a full year. The pilot becomes harder to call a success. But it tests the philosophy, not one department's enthusiasm. The real test of quality culture: does it survive when its leader leaves?

Key Takeaways

Everyone, Everywhere, Continuously

To recap. TQM is a philosophy: quality made by everyone, everywhere, continuously. Eight principles, with process orientation the most consequential. The patient comes first among several customers. Managers move first: commitment, time, tolerance for bad news, and data that can change their minds. And watch for delegation, missing measurement, and reversion under pressure.

About Healthcare Organization and Management at UPI Study

Healthcare Organization and Management (Health 302) is a self-paced online course of 105 video lessons in 18 chapters, from health systems and the law to ethics, leadership, teams, strategy, informatics, finance, quality, human resources, marketing and evidence-based practice. It carries a NCCRS credit recommendation for 3 semester credits.

Every lesson transcript is free on pages like this one, and the videos are free with a free UPI Study account. Enrolling adds a practice quiz after each lesson, the graded work and final exam that earn the credit, lifetime access, and an official transcript on completion. UPI Study has helped over 130,000 students with college credits. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

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Why take it here

Why students take Healthcare Organization and Management with UPI Study

How hospitals and clinics are runHealthcare Organization and Management covers how care organizations are led and run: health law and ethics, leadership and teams, strategic planning, health informatics, budgets, quality improvement, staffing and marketing. It is a core course in healthcare administration and health management degrees.
Credit at a fraction of the priceThe same 3 credits can cost $750 or more at a US college. Here it is one payment, self-paced, with lifetime access.
Finish your degree soonerTransfer credits reduce the courses you still owe, so you can graduate earlier or lighten a heavy semester.
Strengthen an applicationA completed college-level course on an official transcript shows admissions and scholarship committees you can do the work.
Study on your own scheduleNo start dates, no deadlines. Watch the lessons, practice, and take the final when you are ready.
130,000+students helped with college creditsACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Where the credit goes

Universities that work with NCCRS

Healthcare Organization and Management carries a NCCRS credit recommendation. These universities work with NCCRS; some are UPI Study's signed partners. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Thomas Edison State UniversityThomas Edison State UniversitySigned partnerUniversity of the PeopleUniversity of the PeopleSigned partnerCharter Oak State CollegeCharter Oak State CollegeSigned partnerStrayer UniversityStrayer UniversitySigned partnerColumbia Southern UniversityColumbia Southern UniversitySigned partnerIndiana TechIndiana TechSigned partnerPenn StatePenn StateWorks with NCCRSSouthern New Hampshire UniversitySouthern New Hampshire UniversityWorks with NCCRSSUNYSUNYWorks with NCCRS +many more cooperating universitiesFind my college →

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FAQ

Questions students ask us

About Total Quality Management in Healthcare Organizations

What is total quality management in healthcare?
Total quality management, or TQM, is a philosophy holding that quality is produced by the whole organization, continuously, rather than inspected in at the end by one department. Quality is everyone's job, covers every process, and is pursued permanently. TQM grew from manufacturing, shaped by W. Edwards Deming and Joseph Juran in postwar Japan, and entered health care in the late 1980s.
Who is the customer in healthcare quality management?
Health care has several customers. The patient judges access, communication, dignity, and waiting. The payer cares about cost and documentation. The referring clinician decides where patients go. Internal customers are the next steps in a process, such as the unit receiving a patient from the emergency department. The patient's interest comes first, even when other customers are easier to measure and please.
What does process orientation mean in quality management?
Process orientation holds that most variation in results comes from how work is arranged, not from individual people. After a failure, a blame response asks who failed, while a process response asks how the work made the failure possible, which changes the odds of it happening again. Accountability still exists, but it is assigned after the conditions are understood.
Why do TQM programs fail in hospitals?
Three patterns sink most efforts. Delegation hands the program to a quality office while operating managers keep behaving the same way. Absence of measurement leaves no baseline or balancing measure, so every project looks successful. Reversion under pressure brings back blame and cuts protected time, which teaches staff the philosophy was never real. Reversion is usually the most damaging of the three.

About the Healthcare Organization and Management course

How many college credits is Healthcare Organization and Management?
Healthcare Organization and Management (Health 302) carries a NCCRS credit recommendation for 3 semester credits. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.
How much does Healthcare Organization and Management cost and what is included?
$250, paid once, with lifetime access: all 105 video lessons, a practice quiz after each, the graded work and final exam, and an official transcript when you finish. Students who want several courses choose UPI Study PRO instead.
Which universities accept UPI Study credits?
UPI Study has signed partner agreements with universities such as Thomas Edison State University, University of the People and Charter Oak State College, and works with universities such as Penn State, SNHU and SUNY. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities. Use "Find my college" on this page to check yours.
How long does Healthcare Organization and Management take?
It is self-paced with no deadlines. The 105 lessons total about 17 hours of video; most students add reading and practice time and finish in a few weeks to a few months, on their own schedule.
How are the exams done?
Quizzes and assignments are online in the course. The final exam is taken online with proctoring; a person on the UPI Study team checks assignments, usually within two days.
How do my credits reach my college?
When the course shows 100% complete, request the official transcript from your dashboard. It is sent to the college you name, and you can send it to more than one. Check your college first with "Find my college" on this page, or ask Athena.

Ready for the full course? Earn 3 credits in Healthcare Organization and Management.

105 video lessons, a quiz after each one, and the graded work that earns the credit. Recommended for credit by NCCRS.

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Healthcare Organization and Management
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