Quality Management in Australian Healthcare Sector

This paper examines and elaborates in depth the topics of TQM and Continuous Improvement systems as applied by the Australian healthcare sector. In particular, it seeks to identify and discuss TQM and CQI practices in relation to quality achievement and customers’ satisfaction in the hospitals across Australia soil.

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Running Head: QUALITY MANAGEMENT
Quality Management
Name of the Student
Name of the Instructor
Name of the institution

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ABSTRACT
Healthcare system is the major stakeholder in the contemporary world we are inhabiting
today. Quality healthcare must be guaranteed to all the patients seeking available medications in
the facilities. Poor and low-quality services in hospitals can lead to detrimental results such as
loss of lives and development of unnecessary complications among the patients. Previous
researches indicated that 50% of the mortalities in Australian hospital between 1999 and 2009
were as the results of inefficient management of quality in healthcare sector.
This paper examines and elaborates in depth the topics of TQM and Continuous
Improvement systems as applied by the Australian healthcare sector. In particular, it seeks to
identify and discuss TQM and CQI practices in relation to quality achievement and customers’
satisfaction in the hospitals across Australia soil. The research recommends all stakeholders to
join hands in the improvement of quality healthcare. The paper also indicates a slight
improvement in the adoption and implementation of TQM and CQI in the past 1.5 decades.
Total Quality Management (TQM) - This is the organization approach to the long-term
triumph of the institution. Its aim is customers or services recipients’ satisfaction (patients in this
case)
Continuous Quality Improvement (CQI/CI)- This is philosophy used by the management used
in an organization to reduce the waste, increase work efficiency, and to increase employees and
customers satisfaction.

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INTRODUCTION
Much has been researched and recorded about Continuous Improvement (CQI) and TQM
in manufacturing industry; however, less focus has been paid to the healthcare sector hence little
efforts in the application of these quality approaches. This has led to poor services in a number of
hospitals and a lack of confidence from the customers and patients. This, in other words, relates
customers' satisfaction directly hence the need to be addressed.
LITERATURE REVIEW
Overview of TQM and Continuous improvement
Australian Council on Healthcare Standard was formed in 1976 with the aim of quality
management as the main motive (Agarwal, Green, Agarwal & Randhawa, 2016). However, this
council has not been able to probe the quality module of the hospital's services to the maximum.
Low-quality services are still experienced to date especially in the rural amenities (Dawson,
Stasa, Roche, Homer & Duffield, 2014). Regarding the recent survey done in New South Wales
hospitals, only 57 out of the total 92 hospitals surveyed have clear TQM and CQI systems. This
is a calling alarm in this sector of the economy.
Quality in healthcare over the decades is viewed by practitioners, patients, services
suppliers, and the general community in diverse views. The customer’s view of quality is reliant
on the convenience of the care, how able they received the care, service provider, fastness in
service delivery and how gentle the health practitioners were at the time of service delivery.
According to Tohamy, Raoush, Doweri& Alkhatib (2015), patients’ views of the quality of
health care are grounded in the whole process.

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TQM concepts in regard to CQI were developed in the USA in the early 1930s. The
Concepts were applied during post-war with Japan (Andrews, Suriadi, and Wynn &
Hofstede.2017). Many pieces of research have associated USA success in that war with the
adoption. While quality management methods outlined by Abri and Balushi (2014), were
initially useful to the engineering sector, there has been a tremendous increase in their
applications in the healthcare sectors. Hospital systems have begun to apply these concepts in
Australia over the last few years (Fryer, Antony & Douglas. 2015) This has been motivated by a
number of factors such as increased costs of providing health care, poor services in some of the
hospitals and the need to respond to the knowledgeable clients who expect more details and
contribution in the services offered (Ismail, Khurram & Jafri. 2011)
Health facilities in Australia must meet compliance with the specified accredited
procedures. This should be done for both TQM and CQI under the Healthcare Act 1997.
Development of measurement and monitoring systems in health facilities in most cases are
believed to be straightforward, easy to realize (Healy. 2016). However, hospitals are part of the
broad service industry and in this case, they contain many hidden and intangible factors that are
involved in the delivery of the health care to the patients. In most cases, the impact of TQM and
CQI in healthcare delivery are viewed by many on the basis of customer perceptions of the
services. This view of the quality in most cases is not always clear. According to Kronick et al.
(2015), most customers are unable to openly express their opinions on the nature of the services
received. This may be associated with the fear of victimization by the authority involved.
(Kristensen et al. 2015).

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Total Quality Management System in the healthcare
TQM strategies applied in the healthcare organization in Australia as specified by the
National Health Strategy involve community participation in two main levels. The first
participation is related to the separate decision-making. This recognizes the ways clients can
contribute to their personal healthcare (Dawson, Stasa, Roche, Homer & Duffield, 2014). It
involves suggestions for improvement of services delivery in the hospitals. The second strategy
is the participation by the whole community groups. According to Ooi, Lin, and Tan & Yee.
(2011), community participation in TQM in healthcare services is of three categories:
1. Internal participation- The employees' participation in organization enhancement at all
the stages of an organization
2. External participation- The public who have an extensive relationship with the hospital
by providing goods or services to the organization, and
3. The patients and customers of the hospitals, whose concern is in practical and personal
features of the services.
The participation of all stakeholders in the healthcare services system is considered as the main
aftermath and pointer of superiority in TQM. Leggat, Bartram, Stanton, Bamber &Sohal.
(2015), suggested that changes in organization methods as dictated by the TQM have a key
influence on the organization accounting for the function in healthcare. TQM requires new
approaches to allow the effects of deteriorating quality to be assessed extensively.

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Critical factors that influence TQM in the healthcare sector
TQM adoption and implementation require a transformation in the structure, system, and
process in order to achieve improved performance. According to Shah and Rahman 2016, there
are seven factors that greatly influence the TQM in the healthcare sector. These are:
Factors Level of influence (%)
Management obligation 33
Staffs involvement 20
Consumer satisfaction 14
Cooperation and teamwork, 12
Processes, 10
Continuous enhancement, 6
Training and the culture
modification
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Source: Australian Healthcare standard data (2017)
Continuous Quality improvement Implementations
Trying to compare the CQI procedure in healthcare and manufacturing sector, Partington,
Wynn, Suriadi, Ouyang & Karnon. (2015), recorded that CQI procedures consist of undeviating
movements, repetitive stages, standardized inputs, high analyzability, and little employee

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discretion in manufacturing industries. Nevertheless, health sector CQI procedures include non-
standardized and flexible inputs, non-repetitive processes, erratic demand points and high
employee discretion
Australian accreditations system for the health system specified four major standards for
CQI system. These standards generate more than 40 outcomes. These principles are:
1. Administration systems, recruitment and Organisational growth
2. Wellbeing and Personal Care
3. Local Lifestyle
4. Physical Setting and safety structures
These principles are generally very comprehensive to cover every aspect of service
delivery. Each standard has several results that are also comprehensive. They can possibly be
applied to the diverse levels of services needs in the whole system. The outcomes are very broad
and intangible in most cases. Due to the way many healthcare aftermaths are articulated, it is
more suitable to monitor the procedures. This leads to the outcomes rather than just
endeavouring to gauge the outcome alone (Alolayyan, Mohd, Idris, & Ibrehem. 2011)
According to Kronick et al. (2015), there are three types of monitoring in relation to CQI
in the healthcare.
1. Anticipatory monitoring; Anticipatory or prospective monitoring tries to judge on the
projected clinical involvement before it occurs or applied.
2. Simultaneous monitoring; this arises in the progression of the care. It is done
occasionally when things that may prompt a review of a service care happens.

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3. Reflective monitoring; this is performed by reviewing the medical health records to pass
the judgment pertaining to the quality of the service care.
Talib, Yang & Rajagopalan. (2013), said that the legitimacy is one of the most significant
aspects involved in the case of measurement and monitoring procedure. Validity
according to him covers two main area:
1. The accuracy and the precision of the information.
2. The justification of the implications drawn from the figures and values.
In most cases, statistical procedure control techniques are applied in the healthcare sector
to recognize and analyze the potential, simultaneous and retrospective evaluation of the data in
advancing the healthcare services for protective, intervention, and corrective measures.
Kristensen et al. (2015) gave suggestions on seven steps for CQM in healthcare:
1. Identification of the Problem
2. Surveillance/Observation
3. Scrutiny/Analysis
4. Action
5. Check and monitor
6. Implementation and Adopt
7. Conclusion

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DISCUSSION AND ANALYSIS
Limitations and shortcomings
TQM and Continuous improvement implementation in the health care system in Australia
faces a number of obstacles and short comes. Previous statistics indicated that the adoption is
1.37% lower than other adoption rates. The implementation relies majorly on the capability of
the management to embrace and apply their values and philosophies in the healthcare systems.
This is, however, not practised by current management in public hospitals. Ineffective TQM and
CQI determinations in the healthcare management is ascribed to the departmentalized, inflexible
and, classified structure, expert independence. Other factors include uneasiness among
executives and hitches encountered in assessing healthcare procedures and outcomes. Hindrances
to achievement may also include inconsistence executives and employees’ obligation to the
participation of the concepts in the daily activities. Inefficient management and, lack of a
qualitative- oriented philosophy, inadequate training, and insufficient resources also play a big
role in the pullback. These limitations are expected to continue in the future years if the current
trend is something to go by.
According to healthcare incidents metric, hospitals in Australia provided the following data
which measure the quality and level of commitments in hospitals:
1. Administrative: 13%
2. Medication: 33%,
3. Falls: 13%,
4. Non-medication related: 34%,
5. Other: 6%.

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The metric is very important since it provides data on the quality of health care received by
patients. According to this data, it is clear the healthcare sector has to improve on the quality in
order to curb those incidents.
According to Kronick et al. (2015), failures in TQM and CQI can be broadly categorized into
three main groups.
1. Inappropriate or Ineffective models
2. Inappropriate or ineffective implementation methods
3. An inappropriate environment for the implementations
Key risks and issues
Risks associated with the poor or failure of TQM and CQI implementation in the
healthcare system are manifested by the outcomes in some hospitals in Australia. To begin with,
according to Ooi, Lin, and Tan & Yee. (2011), the lack of customers and patient satisfaction is
one of the risks. A hospital that is not committed to customers’ satisfaction lose the customers to
competitors who respond to their demands.
It is only 367 healthcare facilities in Australia that got 5 stars rating on patient pleasure.
Conferring to current healthcare assessment of data, a overall of 117 hospitals were rated the
lowest position of 1 star; 412 were two stars, 287 got 3 stars; 807 were rated 4 stars, whereas 367
got the uppermost position of 5 stars. This translate into low patients turnout and the negative
image of the hospital to the public.

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Secondly, the workforce in the hospital become disengaged, leading to a decrease in
productivity, and increased attrition in the service delivery. TQM dictates involvement and
engagement of the employees in the service delivery process right from the beginning to the end
on a continual basis.
Thirdly, lack of a document control and management systems prevent the hospital from
delivering professional services, because it lacks formal starting point. TQM specifies the
requirements for development, approval, and periodic review of procedures that govern
healthcare activities.
What was done well?
Over the last five years, the number of the hospital in Australia that has adopted TQM in
conjunction with CQI has increased by an average 13%. This has been associated with a number
of factors such as the need to enter the global market. The global market in healthcare delivery
dictates that the services be delivered professionally to satisfy all the stakeholders associated
with the healthcare facilities (Andrews, Suriadi, Wynn & Hofstede.2017). The hospitals have
adopted operational and information technology metrics/scorecards. According to …….., 87% of
the hospitals in Australia had adopted these metrics by June 2017. The metrics were targeted to
bring equity measures, patient-oriented, effectiveness, timelines and patient safety measures.
In connection with this, the level of confidence from the public to healthcare systems in
Australia has increased to 79.3% in the last few years (Kristensen et al. 2015). This has resulted
in an increase in the number of patients who visits the local health facilities per day unlike in the
past one decade where 4 out of 10 patients visited the healthcare facilities. The number has
doubled in the time span of 10 years.

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What was not done well
Andrews, Suriadi, Wynn & Hofstede. (2017) suggested that the quality management in
the health care system in Australia could have been achieved effectively if the management and
the staffs were holistically involved and engaged. Only a few hospitals in Australia have adopted
the SERVQUAL Model. This model is used to monitor and evaluates the clinical performances
of the practitioners. This model has been proven to improve the quality of health care services
and it could have been better if adopted by all hospitals. In many hospitals in the late 1990s to
date, the quality management has been left to be the role of management alone. Training was not
done to all the staffs in the hospital and most employees misinterpret the concepts of TQM and
CQI. This has led to misunderstanding and poor service deliveries in the hospitals
Improvements in Quality management
According to Kronick et al. (2015), Quality management systems and in specific TQM
and CQI is not an option but a basic in the quality of service delivery in any healthcare facility.
Some hospitals in Australia have adopted the SERVQUAL Model. This model is used to monitor
and evaluates the clinical performances of the practitioners. This model identifies opportunities
for improvement and also recommend mechanisms for suitable improvements. As
aforementioned earlier, this is not a single person or department role but a full organization role.
TQM principles should be clear to every stakeholder in the healthcare facility.
The principles should be printed and posted in every office for staffs, customers, and
patients to familiarize themselves with its content. Another recommendation is on the
frequencies and regularity of monitor procedures. It should be done on a regular basis and
improvements should be done as soon as possible when needed. Proper disciplinary measures

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should be specified for the employees and any person who may intentionally compromise the
quality delivery in the hospitals.
CONCLUSION AND RECOMMENDATION
In conclusion, the research has tremendously highlighted the importance of the proper
quality management systems. It is now evident why the healthcare sector in Australia should
adopt and implement the TQM and CQI in the management of the hospitals. TQM and CQI
relate directly to customer’s satisfaction hence should be highly regarded. Failure to adopt these
concepts as discussed is associated with massive losses and diminishing effects that are directly
linked to poor quality services in the hospitals. Quality delivery has been well elaborated and
with no doubt if everyone performs what their roles well, quality will be achieved effectively in
the hospital systems.

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