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Using TQM's methods in managed care

1. Using Total Quality Management(TQM ) as the basis to improve the in the performance of healthcare Organizations, what would be the expected impact on improved patient outcomes, higher levels of customer satisfaction, lower costs, etc., and list the critical success factors associated with implementing these programs in a health services organization?
2. Which of these management practices be listed as the greatest, second greatest, and third greatest potential benefit for health care organizations?

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RESPONSE:

The simple objective of TQM is "Do the right things, right the first time, every time?The expected impact of using TQM on quality measures is based on the TQM philosophy of continual improvement.

1. This stems from the belief that mistakes can be avoided and defects can be prevented.
2. It leads to continuously improving results, in all aspects of work, as a result of continuously improving capabilities, people, processes, and technology and machine capabilities.
3. Continuous improvement must deal not only with improving results, but more importantly with improving capabilities to produce better results in the future.
4. The five major areas of focus for capability improvement are demand generation, supply generation, technology, operations and people capability.
5. A central principle of TQM is that mistakes may be made by people, but most of them are caused, or at least permitted, by faulty systems and processes.
6. This means that the root cause of such mistakes can be identified and eliminated, and repetition can be prevented by changing the process.1
7. There are three major mechanisms of prevention: Preventing mistakes (defects) from occurring (Mistake - proofing or Poka-Yoke).
8. Where mistakes can't be absolutely prevented, detecting them early to prevent them being passed down the value added chain (Inspection at source or by the next operation).
9. Where mistakes recur, stopping production until the process can be corrected, to prevent the production of more defects. (Stop in time). (http://discoveryfuel.com/leadership-ecology/introduction-and-implementation-of-total-quality-management-tqm-an-overview/)

TQM calls for all managers and employees at all stages of operations to strive towards higher standards and a reduced number of defects.

The critical success factors associated with implementing these programs in a health services organization are identified of a limited number of activities in a specific service area at which an organization must achieve at a high level if it is to be successful. The idea behind critical success analysis is that there are five or six areas in which the organization must perform well and that it is possible to identify them through careful analysis. Critical Success Factors are the areas of your business or project that are absolutely essential to it success. By identifying and communicating these CSFs, you can help ensure your business or project is well-focused and avoid wasting effort and resources on less important areas. By making CSFs explicit, and communicating them with everyone involved, you can help keep the business and project on track towards common aims and goals. (Ginter, et al, 2003, http://books.google.ca/books?id=x6wZQktLbe8C&pg=PA119&lpg=PA119&dq=the+critical+success+factors+associated+with+implementing+these+programs+in+a+health+services+organization.&source=bl&ots=k_DrnDDc-I&sig=9g6wXzJqreprdO-9g4QE5TKF_Pw&hl=en&ei=3IcdSsywB8LcmQfozfi2Bg&sa=X&oi=book_result&ct=result&resnum=4#PPA119,M1)

To make sure an organization considers all types of possible CSFs, the HCO can use Rockart's CSF types as a checklist.

1. Industry - these factors result from specific industry characteristics. These are the things that the organization must do to remain competitive.
2. Environmental - these factors result from macro-environmental influences on an organization. Things like the business climate, the economy, competitors, and technological advancements are included in this category.
3. Strategic - these factors result from the specific competitive strategy chosen by the organization. The way in which the company chooses to position themselves, market themselves, whether they are high volume low cost or low volume high cost producers, etc.
4. Temporal - these factors result from the organization's internal forces. Specific barriers, challenges, directions, and influences will determine these CSFs. (http://www.mindtools.com/pages/article/newLDR_80.htm)

According to Porter, there are several strategic dimensions that capture the differences: specialization, reputation, service/product quality, vertical integration, cost position, service, price policy, relationship with the parent company (Ginter, Duncan & Swayne, 2002, see p. 119). Therefore, in order for quality is to be managed, it must first be understood.
According to TQM philosophy, managers must move aggressively to improve their understanding of quality practices and performance. Desotelle (2009) found that that most features generally associated with TQM - such as training, process improvement, and benchmarking - do not generally produce advantage, but that certain tacit, behavioral, imperfectly imitable features - such as awareness, management commitment, open culture, employee empowerment, and executive commitment, leadership - can produce advantage. The authors conclude that these tacit resources, and not TQM tools and techniques, drive TQM success, and those organizations that acquire them can outperform competitors with or without the accompanying TQM ideology. (http://discoveryfuel.com/leadership-ecology/introduction-and-implementation-of-total-quality-management-tqm-an-overview/).

Research indicates that within each product/market there are some tasks which are more important (i.e. critical) than others for success-success being defined as outperforming the competition in terms of profitability (http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V6K-45TVD7M-9&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=d808ecc35bea5850cd8c3bd438300099).

Ranking the critical success factors (CSF) is important based on the theory of critical success factors as those factors are the areas of your business or project that are absolutely essential to it success. By identifying and communicating these CSFs, you can help ensure your business or projects are well-focused and avoid wasting effort and resources on less important areas. By making CSFs explicit, and communicating them with everyone involved, you can help keep the business and project on track towards common aims and goals.

EXAMPLE: "Farm Fresh Produce"

Consider a produce store "Farm Fresh Produce", whose mission is:

"To become the number one produce store in Main Street by selling the highest quality, freshest farm produce, from farm to customer in under 24 hours on 75% of our range and with 98% customer satisfaction."

The strategic objectives of Farm Fresh are ...

Solution Summary

Concerning using TQM's methods in managed care, this solution addresses the questions in some detail. Supplemented with one supporting article on critical success factors.

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