Total quality management in the health-care context: integrating the literature and directing future research

[Synthetic indicator of compliance with standards for Quality Units of health centers and multicenter prospective pilot study]

BACKGROUND AND OBJECTIVE

In Spain, Quality Units play a key and unique role in advising healthcare centers on the methodology of healthcare quality. The objectives of the study were to develop computer algorithms to obtain a synthetic indicator of standard compliance for Quality Units and to pilot its functioning in these units.

MATERIALS AND METHODS

The Excel program was used to establish evaluation algorithms, and quantitatively interrelate and weight various categories of standards, as a computer evaluation tool, to build a continuous improvement cycle system, and offer a global synthetic indicator of compliance. The tool was tested in a prospective multicenter pilot study, in which coordinators of Quality Units from different health centers and care settings participated, to evaluate the usefulness of the tool and compliance with the standards, in addition to analyzing the content validity of each standard.

RESULTS

The formulas for the structured computer algorithms were developed, consecutively, in a «PLAN-DO-CHECK-ACT» improvement cycle for the 9 categories of standards, resulting in a single synthetic indicator of compliance. Twenty-one Quality Units participated in the piloting. The overall average compliance rate for the synthetic indicator was 55.63% with differences between centers (P=.002) and between categories (P<.0001), but not by autonomous communities (P=.86) or by areas (P=.97). Content validity was ensured through the variable of «understanding» of the standards (P<.001), and through their «justification» with documentary evidence (P<.001).

CONCLUSIONS

The computer tool with the synthetic indicator have allowed for the evaluation of standard compliance in Quality Units of healthcare centers.

A balanced approach involving hard and soft factors for internalizing Lean Management and Six Sigma in hospitals

Purpose

This study examines the theoretical and empirical relationships between LM&SS, human resource management (HRM), climate for LM&SS and outcomes (employee well-being and performance) in hospitals. As part of this research, the authors examine the interplay between “hard” and “soft” practices for LM&SS and “soft” HR practices.

Design/methodology/approach

A cross-sectional, multisite survey study covering all internal service units at all eight Dutch university hospitals was conducted (42 units, N = 218 supervisors, N = 1,668 employees), and multivariate multilevel regression analyses were performed.

Findings

A systems approach involving “soft” LM&SS practices that are specifically HR-related has a positive effect (β is 0.46) on a climate for LM&SS. A climate for LM&SS is not related to perceived performance or employee health. It is, however, positively related to employee happiness and trusting relationships (both βs are 0.33). We did not find that a climate for LM&SS had a mediating effect.

Research limitations/implications

This study shows that a balanced approach involving both “hard” and “soft” factors is crucial to achieving the desired breadth and depth of LM&SS adoption at the macro, meso, and micro levels. The authors found that a climate for LM&SS positively affects employee well-being in hospitals.

Practical implications

In their attempt to create mutual gains for both their organization and their employees, hospitals that adopt LM&SS should foster a climate for LM&SS by embracing a balanced approach consisting of both “hard” and “soft” practices, thereby internalizing LM&SS at the macro, meso, and micro levels.

Originality/value

This is one of the first studies to examine in-depth the impact of “hard” and “soft” LM&SS on both employee well-being (subdivided into different components) and performance in healthcare, as well as the role of “soft” HRM in this relationship. Linking LM&SS, HRM and outcomes to a climate for LM&SS is relatively a new approach and has led to a deeper understanding of the mechanisms underpinning the internalization of LM&SS in healthcare.

How to invest in total quality management practices for enhanced operational performance: findings from PLS-SEM and fsQCA

Purpose

Consumer expectations of quality have grown in recent years, forcing organisations, both service and manufacturing, to adopt total quality management (TQM) principles to satisfy customer demands efficiently. However, previous studies on the performance impacts of total quality management practices have mainly focused on the financial performance of firms in the manufacturing sector. This study focusses on the research questions: (1) What is the effect of TQM practices on operational performance? and (2) How do TQM practices combine to influence the operational performance of healthcare facilities?

Design/methodology/approach

Using a sample of 154 health facilities (i.e. private hospitals, pharmacies, maternity clinics, and diagnostic centres), the authors applied symmetric (PLS-SEM) and asymmetric (fsQCA) data analysis approaches to examine how TQM practices influence the operational performance of health facilities in the Ashanti Region of Ghana.

Findings

The PLS-SEM results revealed that five out of the seven TQM practices investigated influenced operational performance. However, the fsQCA results identify five different complex combinations of TQM practices that lead to operational performance.

Research limitations/implications

Longitudinal studies can be conducted in the future to assess changes in the variables over time. A control variable, such as firm size, should be considered to assess the level of implementation of TQM practices based on firm size. A different performance measure, for instance, sustainability indicators or the balance score card, could be used to examine performance.

Practical implications

A proper and coordinated integration of the TQM practices is required for firms to be able to achieve operational performance. TQM practices vary in their sufficiency for operational outcomes; therefore, management needs to carefully consider their implementation as part of the organisation's strategy.

Originality/value

This research, by focussing on TQM practices from both symmetrical and asymmetrical perspectives, contributes to the understanding of the literature on TQM, thereby providing actionable insight on how to invest in the various TQM practices for improved operational performance.

Implementation of online video consultations in a regional health network: a management feasibility analysis from an orthopedic perspective

Introduction

Regional health care networks with interfaces between clinics, general practitioners and patients can act faster when utilizing digital measures. This manuscript describes the establishment of an online video consultation service in a clinic and its broad health care region to exemplify challenges and solutions for potential future approaches from a management perspective.

Method

The underlying pilot project was planned and implemented for follow-up monitoring and consultative presentation of orthopedic and trauma patients within the Bundeswehr Medical Service from 2018 to 2020. With predominantly positive evaluation results regarding quality and acceptance among users, this research investigated organizational and processual aspects including total quality management, strategic control and change management approaches.

Results

The affected main and subprocesses of patient treatment could be streamlined by the project, as physician recommendations and arrangements could be accelerated and patient travel could be significantly reduced. A SWOT and portfolio analysis showed a high potential for improving existing patient treatment processes for health care enterprises via the use of digital technology. The involved staff should be strategically included at an early stage and continuously involved. By means of a PDCA cycle, the processes of the given project could be exemplarily illustrated with an outlook in the future.

Discussion

It has proven successful to consciously use management approaches to establish telemedical integrated care structures in a health region. Recommendations for the strategic introduction of an online video consultation for regional network strengthening and care development for a patient-oriented increase in efficiency could be compiled.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08352-0.

Using Process Flow Disruption Analysis to Guide Quality Improvement

BACKGROUND

Process flow describes the efficiency and consistency with which a process functions. Disruptions in surgical flow have been shown to be associated with an increase in error. Despite this, little experience exists in using surgical flow analysis to guide quality improvement (QI).

STUDY DESIGN

In a 900-bed teaching hospital with an annual surgical volume of 24,000 cases, a 4-month observational study of process flow was done by experts in complex system evaluation. Identified flow disruptions were used to guide QI. Statistical analysis included descriptive and bivariate techniques.

RESULTS

More than 200 unique process data points were evaluated. There was a high degree of variability in completion of 79 individual intraoperative data elements. Lack of completion of all elements of the time out was associated with number of times the operating room door opened during case (19, 11-27; p = 0.01). Flow disruptions were used to direct surgical QI. One example was a disruption affecting the use of Sugammadex. Resolving this flow disruption resulted in a 59% reduction in the incidence of postoperative respiratory failure (p < 0.01) and a direct and variable cost savings of $447,200 and $313,160, respectively, in the first 12 months.

CONCLUSIONS

The use of process flow analysis to direct surgical quality initiatives is a novel approach that emphasizes system-level strategy. Resolving flow disruptions can lead to effective QI that embraces reliability by focusing attention on common processes rather than adverse events that may be unique and therefore difficult to apply broadly.

Practical implications of cost of quality: a systematic literature review

Purpose

The present study focuses on the cost of quality (CoQ) based on which organizations can evaluate their quality-related activities in economic terms. The purpose of the study is to identify the CoQ practical implications as well as to group them into logical themes.

Design/methodology/approach

A systematic literature review (SLR) was conducted based on well-known academic publishers, such as Emerald Insight, Elsevier/ScienceDirect, SpringerLink, Taylor & Francis, Wiley and Scopus. Sixty-seven peer-reviewed journal articles in the field of CoQ were collected, which were published between 2010 and 2019. The “affinity diagram” was applied to group the practical implications identified into logical themes.

Findings

A plethora of CoQ practical implications were identified and grouped into the following meaningful themes: benefits of CoQ measurement, effects of CoQ, business sectors measuring CoQ, factors influencing CoQ measurement, CoQ elements, future research in CoQ and the role of government.

Research limitations/implications

The limited number of the publishers and keywords used to search for the articles of interest, as well as the subjectivity of grouping the large number of the practical implications into themes are the main limitations of the present study. These limitations constitute the basis upon which future literature review studies can be designed.

Practical implications

The present study by presenting analytically and in summary (through the themes revealed) the CoQ practical implications, provides all the respective available literature in a single study for the benefit of practitioners and academics. Thus, clear and straightforward guidelines are given to practitioners with regard to CoQ issues and academics with regard to research topics of high interest.

Originality/value

No previous SLR study focusing on analyzing the practical implications of CoQ has been published so far.