21.06.2019 in Medicine
Quality Management in Health Care


In the past five years, the quality of health care in America has increased drastically. Legislators, medical institutes, hospitals, and physicians have vigorously joined policy discussions that support improvement of the health care quality. With high competition among medical facilities, patient expectations, and advanced medical sciences, many health care centers are becoming complex organizations. For this reason, they strive to find resources that can satisfy their patients. Total quality management has therefore been a useful system to address hospital problems and assist in improving performance. The system aims at satisfying customers, increasing revenue, reducing cost, and empowering employees. It mainly intends to enhance the quality of services and goods to satisfy customers’ needs. The paper will describe Pennsylvania Hospital with respect to its total quality management and continuous quality improvement in healthcare.

Pennsylvania Hospital

Pennsylvania Hospital has been the first national hospital in Philadelphia in terms of treatment techniques, medical research, and patient care for over 200 years. The hospital offers comprehensive medical services, including complex surgical and medical treatment by a team of qualified and experienced medical professionals (McLaughlin & Kaluzny, 2006). Some of the services offered by this hospital include urology, cardiac care, oncology, behavioral health, neurosciences, and fertility care.

Members of the Total Quality Management

Pennsylvania Hospital delivers perfect services through facilitation of some people and they include the director of quality management, quality controls managers, physicians, and clinic leaders. This team works together to provide patients with the best practices that can resolve care issues. Teamwork ensures efficiency of services and overlap of duties that assists in ensuring that all patients are served at the right time and in the correct way. It refines workflow processes, which guarantees that effective health care is granted to all patients (McLaughlin & Kaluzny, 2006). The quality management team at Pennsylvania Hospital continuously examines its patients’ data with the purpose of determining areas that need additional improvement.


Members Appropriate in Number and Composition

Pennsylvania Hospital has 300 members in the quality management team. The number is appropriate because the team can provide full medical attention to any patient walking into Pennsylvania Hospital. The team achieves its effective provision of services by following some effective interventions recommended by the Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS). The two bodies rank hospitals in terms of quality services they give to their customers to satisfy their needs (Vincent, 2010).

The CMS ranks hospitals based on some core and sub-core measures. These are how a hospital attends to a patient when he or she enters the hospital. For instance, in case of a heart attack, the CMS looks at how the hospital gives medication to such patients, in what amount, and other extra help given to the patient after taking the medication. The help includes monitoring the patient at home or by calls to check the progress of health. Moreover, the hospital has to follow the patient’s medication routine (Carey & Lloyd, 1995). Most hospitals only administer medication and stabilize the patient, but Pennsylvania Hospital follows both the industrial protocols and the CMS’s recommended interventions by going an extra mile of checking on patients to monitor their improvement.

Previous Plans of Action Evaluated and Measures for Success

Plans of action of Pennsylvania Hospital have been measured and evaluated to determine their success. The entire health system of Pennsylvania Hospital prioritizes the patient safety as well as the quality care. Medical professionals focus on a continuous monitoring to improve the quality of safety and care given to patients. For these actions, Pennsylvania Hospital is ranked as one of the best health facilities in terms of the provision of quality health care. The hospital is ranked in terms of reduced re-admissions, reduced mortality, patient satisfaction, and infection control. These measures show how the hospital provides the best services that ensure patients’ safety and improvement under such conditions as stroke, pneumonia, and attacks. There are increased survival rates for patients receiving any surgical and medical care in Pennsylvania Hospital (McLaughlin & Kaluzny, 2006).

The presence of physicians with outstanding skills and the use of the most advanced technologies that assist with detecting and treating various diseases at their early stages influence the success of Pennsylvania Hospital. These technologies respond quickly to conditions that threaten the life of a patient. Pennsylvania Hospital shares its educational information through their website, which has helped many people in the adaptation to a healthy life to avoid various lifestyle diseases such as diabetes and obesity that affect many Americans. The website provides information on services offered by the hospital and provides contacts that one can use in case of emergencies.

Things to Be Done Differently

A high medical cost is one of the reasons that hinder many patients from going to hospitals that give quality health care services. To attract more patients and receive quality health care, hospitals, including the Pennsylvania one, should offer affordable services. Quality health care should be given to people who need it the most. Hospitals that provide quality health care should reduce treatment cost to help those who have life-threatening conditions, but lack  income to cater for their treatment (McLaughlin & Kaluzny, 2006).

The lack of quality health care is caused by the absence of commitment on behalf of the management and inadequate support from health professionals. The tendency to separate total quality management within the organization and integrate it into the institution’s policy results in poor health care (Carey & Lloyd, 1995). Many health facilities are managing the quality of health care for the sake of rankings by commissions rather than for the benefit of patients who desperately need quality treatment. Patients, therefore, end up suffering due to poor services offered in hospitals.

Principles of Total Quality Management and Continuous Quality Improvement in Health Care

Quality management in health care refers to the measurement of the quality of patient care. It further includes development of quality measures, implementation of these measures, and their monitoring over time. One can observe whether certain measures lead to increased or decreased quality of health care in the organization, health care providers, or communities (Morfaw, 2009). Total quality management is based on three basic principles, namely: customer focus, teamwork, and continuous quality improvement.

Continuous Quality Improvement (CQI) 

Continuous quality improvement is a principle based on persistent search for improvement in a process. The main aim is to get a system or a process that is improved and gives better outcomes than the previous one. The medical field has been adopting continuous quality improvement slowly despite the fact that it has vast and complex information about patients’ care (Vincent, 2010). However, some hospitals rely on paperwork and search abilities to trace patients’ information across files, journals, and books that support their decisions. Searching for information is an enormous task, but this task can be simplified by using computer applications. Past data can be easily retrieved and an organization can easily check on improvement of a patient over time (McLaughlin & Kaluzny, 2006).

Customer Service

This principle is based on providing customers with services that satisfy their needs. As physicians continue to improve the quality of their services, they should satisfy customers’ needs at the same time. For instance, Pennsylvania Hospital uses advanced technologies to provide better treatment of various diseases. The central goal is to come up with better ways that can assist an organization with improving services they offer to their patients and how they operate (Carey & Lloyd, 1995). In turn, good services will attract many customers who want to enjoy quality services and the organization will thus enjoy huge profits that come with many customers.


Teamwork, in this case, refers to involvement of all employees in the deliverance of quality services to patients. As a team, employees have one goal of prioritizing needs of patients and their contributions are not judged by supervisors, but by group members (Carey & Lloyd, 1995). Teamwork helps in the development of good ideas that can improve the quality of health care. It also helps with better coordination of work, which helps in providing an environment conducive to serving customers.

A Real Approach to Decision-making

Managers can measure progress and solve problems of an organization by collecting, analyzing, and implementing accurate, objective, and timely data. They should consider potential problems and find their solutions so that if such problem emerges, proposed solutions can be used to solve that problem (McLaughlin & Kaluzny, 2006). Therefore, managers should have good problem-solving skills that can help them come up with solutions whenever a problem emerges.

Relationships among Mutually Beneficial Suppliers

An organization interdepends mutually with its supplier. With a useful mutual relationship, it enhances creation of valuable products and services that can attract many clients. A good relationship with the supplier will enhance teamwork, good communication, and healthy relationship that facilitate with the supply of quality products that are the best to customers (Marszalek-Gaucher & Coffey, 1993).

Theories of Total Quality Management and Continuous Quality Improvement in Health Care

The quality improvement approach has been developed to improve the existing product or service and to develop a new product or service that offers the best outcomes to customers. The theory of continuous quality improvement states that to achieve real improvement when producing a quality product or service, one should first understand and revise procedures performed during the production process. Revision during the production process is done by studying data provided in the process of creating the product. Revision reduces complexity and reworks, as well as decreases waste. Collaboration and communication are other components inherent in continuous quality improvement. Members can communicate about the way processes are done, while analysis is done so that people can make changes to improve the product. Analysis of processes can provide ideas for new and better products and processes.

The CQI process is facilitated by the Plan-Do-Check-Act cycle (PDCA). During the Plan step, the team analyzes problems through discussions and brainstorming. Data are then collected through a survey, benchmarking, maps, and flowcharts in order to measure, define, and understand problems within the process. With a proper understanding of the problem and its causes, one devises solutions to the problem using problem-solving skills. The Do step facilitates implementation of the best solution that can solve the problem (Vincent, 2010). The Check stage examines results of the chosen solution that is analyzed to verify whether they have improved the system or the process that had the problem. The Act stage involves systemization of the new improved process. The cycle repeats constantly to improve the new process with the aim of getting the best results.

Concepts of Total Quality Management and Continuous Quality Improvement in Health Care

Total quality management is aimed at achieving constant improvement of all employees. In the settings of health care, quality levels are measured in terms of patient satisfaction and health outcomes. These factors become a competitive advantage for a healthcare facility (Morfaw, 2009). The main concern of the patient is good health, and if a health facility offers quality health care, the patient will choose that health facility. There are two total quality management concepts and they include six sigma. They measure goals for quality improvement and process approach to business challenges of an organization.

Measurements of Goals for Quality Improvement

The main goal of the TQM is to measure outcomes to examine quality levels of products and services offered. In a health care facility, customer satisfaction estimated by market and survey can help measure the main TQM goal of quality improvement. Smaller hospitals are more successful in implementing improvement than large hospitals because their systems are smaller and more easily manageable. Large hospitals should put in place systems that can measure outcomes and improve their complex facilities. Therefore, health care should always measure outcomes to ensure that patients receive services and products that are of high quality. 

The Process Approaches Business Challenge of the Organization

The process approach is measured by the cost of service or product and the cost of labor of producing the product. It looks how the organization functions in organized, but interconnected steps that can be improved to achieve better results (Marszalek-Gaucher & Coffey, 1993). The processes of producing a product can be altered to produce a product that will suit the needs of the customer. In this case, an organization is capable of overcoming the challenge of meeting customers’ needs by producing what they want.

Six Sigma and TQM

Six Sigma is a performance strategy that motivates employees and eliminates underperformers. Motivation can lead to the high performance of employees, which then leads to the production of quality goods and services (Morfaw, 2009). Although elimination of underperformers leads to intense competition, which conflicts team building, yet it encourages employees to perform well at work. For instance, hospitals with staff associates in a competitive environment have more implementation achievement than hospitals with the staff that are not economically challenged.

Approaches to Enacting Quality Improvement

There are three approaches that enhance quality improvement namely the Deming’s steps for Management, Juran’s Steps to Quality Improvement, and Crosby’s Steps to Quality Improvement. The Deming’s approach emphasizes that an organization should constantly create a reason for the improvement in goods and services (Morfaw, 2009). Leaders should not depend on inspection to attain quality products. Juran’s steps give the alternative for designing projects that can encourage production of quality goods and services. The projects should have missions where theories are tested to determine, which theory will work best to produce the desired products. Crosby’s steps highlight that management handles quality management. Therefore, representatives should be elected in each department. These representatives should determine where quality problems are present. Solutions are then identified to correct the problems and supervisors are trained to check for quality improvement. Employees are also encouraged to communicate with areas that hinder them from providing quality services to customers (Marszalek-Gaucher & Coffey, 1993).


To implement total quality management, managers and other leaders of an organization should lead the entire workforce to the right direction. These leaders should provide commit fully to the achievement of total quality of health care and at the same time integrate total quality management to the organization’s system so that quality levels can be easily monitored. Health professionals who are the main employees in a health facility should provide their full support in the provision of services and products that are of high quality to meet needs of customers. Additionally, there exist powerful subcultures in a health facility such as physician subcultures and manager subcultures, each with their own view on quality services. Therefore, leaders should develop an organizational culture that supports continuous organizational improvement. Employees should have an environment conducive to their involvement in the production of quality services and products that can satisfy customers’ needs.

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