Comparing and Contrasting Approaches to Quality Management in Healthcare

This workbook explores different approaches to quality management in healthcare, including Deaming, Juran, and Ishikawa. It discusses the key elements and quality strategies of the Toyota Total Quality Production System and the concept of lean healthcare. The workbook also covers the importance of quality improvement in healthcare service management and the relationship between healthcare quality and patient safety. It delves into the factors contributing to adverse events and the distinction between system and individual factors. Overall, it provides valuable insights into improving healthcare quality.

WORKBOOK

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................4
MAIN BODY..................................................................................................................................4
ACTIVITY 1...................................................................................................................................4
Comparing and contrasting key features of the deaming, Juran and Ishikawa approaches to
quality management and how it helps in improving health production quality..........................4
Key elements and quality strategies of Toyota total Quality Production System.......................5
Concept of lean healthcare with example of successful use of lean in healthcare organization
along with some barriers of its successful use.............................................................................6
ACTIVITY 2...................................................................................................................................6
What is healthcare quality...........................................................................................................6
Importance of quality improvement in healthcare service management.....................................6
Necessary condition required for quality improvement..............................................................7
Relationship between healthcare quality and patient safety........................................................7
ACTIVITY 3...................................................................................................................................7
Adverse events and how frequent are these.................................................................................7
Types of Adverse events..............................................................................................................8
Preventable and non-preventable adverse events........................................................................8
Reasons for distinction made between the systems and individual factors that are contributing
to adverse events..........................................................................................................................9
ACTIVITY 4...................................................................................................................................9
Factor of adverse events and which of them are systems or individual factors.........................9
Causal and contributing factors classified as system or individual factor.................................11
The problems identified during the inquiries but not identified through Accreditation............11
Health and aged care are those harm to be susceptible.............................................................11
Public inquiries are achieving the long term improvement in the quality and health services..12
ACTIVITY 5.................................................................................................................................12
The impact of organizational culture on health care quality and safety....................................12
The type of cultural supports that delivery for high quality and safe care................................12
A safety culture..........................................................................................................................13

The person centred care integrated to safety culture.................................................................13
ACTIVITY 6.................................................................................................................................13
Clinical governance...................................................................................................................13
Importance of clinical governance in health and aged care organizations................................13
Common elements of clinical governance frameworks.............................................................14
Barriers that need to be addressed for successful clinical governance......................................14
CONCLUSION..............................................................................................................................14
REFERENCES................................................................................................................................1

INTRODUCTION
The degree to which healthcare services increase likelihood of desired health outcomes is
known as healthcare quality (Mannion and Davies, 2018). This study will discuss differentiation
between Juran, Deaming and Ishikwa approaches in healthcare. Further, it will discuss
effectiveness of Lean and total quality management approaches for improving quality of
healthcare. It will also discuss some different types of adverse events that have negative impacts
of patients’ health. There is interrelation and linked between patients’ health safety and quality of
healthcare that also this study will discuss.
MAIN BODY
ACTIVITY 1
Comparing and contrasting key features of the deaming, Juran and Ishikawa approaches to
quality management and how it helps in improving health production quality
Deaming Juran Ishikwa
Definition It is a process of
quality improvement
in which activities are
being performed as
per the expectations
and needs of
customers. Variances
do not affected largely
by workers’ activities.
Workers play a vital
role in this quality
management approach
because of being close
to activities that
impact quality.
It is conformance to
requirements, not as
goodness. Workers
are being motivated
by managers in order
to improve quality of
products and services.
Degree of
management
involvement
Process of quality
improvement is being
done in the broad
room which means all
participants take
responsibility of
It is believed that
majority of problems
to quality is all
because of fault of
poor management and
not because of poor
Senior manager is all
responsible for defects
in quality and process
of quality
improvement also

problems to quality. workmanship (Power,
2019). It means senior
manager is
responsible for quality
problems.
starts from the top.
Performance standard In this context, it is
found that it
eliminates
management by
numbers and
numerical goals.
There is a zero effects
in performance
standard. Manager
encourages
individuals in order to
develop goals for
themselves and others
as well.
On the basis of above discussed comparison, it can be said that the common goal of all
approaches is to improve quality of services and in healthcare, by motivating all workers, doctors
and nurses, quality if healthcare services are being improved.
Key elements and quality strategies of Toyota total Quality Production System
In regard to total quality management it can be said that it consists of several elements and
effective strategies that make Toyota able to improve quality of products. Toyota is known as the
king of TQM production. As per this strategy, employees are being motivated to improve process
of production in order to improve quality of products and services. The ultimate goal of this
strategy is to foster customers’ loyalty by providing a level of service that keeps customers’
coming back again. Some main key elements of this approach, that can also be used and focused
in healthcare sector for providing qualitative services include: Leadership, customers’ focus,
process approach, continuous improvement, relationship management and evidence base
decision making.

Concept of lean healthcare with example of successful use of lean in healthcare organization
along with some barriers of its successful use
In regard to lean healthcare it can be said that it is the application of lean ideas in healthcare
that is being used for decreasing waste with ongoing process improvement. This lean healthcare
can also help healthcare providers in improving patients’ satisfaction and care outcomes while
reducing costs (Maijala and et.al., 2018). Lean and Six Sigma are associated with each other’s
and in regard to effectiveness of six sigma it can be said that it helps healthcare professionals in
reducing medical errors. This approach reduces variation by decreasing errors to a specific
statistical measure. Along with success, there are some barriers that might affect quality of care
such as:
 Lack of commitment as well as support from management.
 Lack of engagement of employees.
 Inadequate training to employees about using this approach.
 Lack of communication among employees or doctors.
ACTIVITY 2
What is healthcare quality
Quality health care is a care that is being provided by healthcare professionals to patients
by making sure that it is safe, effective, timely and efficient. In another word it can be said that
all healthcare services that have positive impacts on patients’ health and help healthcare
professionals in getting positive outcomes is known as quality healthcare. When healthcare
services and interventions reduces patients’ stay rate in hospitals, decrease errors in medical
process and also decrease adverse event then it is completely known as healthcare quality.
Importance of quality improvement in healthcare service management
Continuous quality improvement in healthcare service management is vital and essential for
several reasons such as:
Improves health of patients: Patients’ health is mainly dependent on quality of care that
is being provided to them and this goal can be accomplished only when manager focuses on
improving healthcare service management.
Reduces per capita cost of care: When patients get qualitative service care and when
healthcare service is being managed in an effective manner then it decreases patients stay rate.

When patients stay in hospitals for short period then it decreases their cost and cost of healthcare
sector (Kilbourne and et.al., 2018).
Along with all these effectiveness, quality in healthcare can make healthcare professionals
in maximizing use of effective care and improving resources efficiency.
Necessary condition required for quality improvement
There are some key components or conditions that are essential for improving quality of care in
healthcare such as:
The problem: When healthcare professionals have depth understanding of patients’ problem
then only they can improve quality of care to patients accordingly.
Consumer focus: when healthcare professionals focus on patients rather than their interventions
then also they can improve quality of care. Patient centred care approach is one of the best
examples of it.
Partnership or team working: It is believed that when workers perform tasks in a team then
they are more likely to get qualitative results and decreasing errors. So, by working in a team,
doctors can lead qualitative healthcare.
Relationship between healthcare quality and patient safety
Qualitative healthcare is directly proportional or associated with patients’ safety. In regard to
patients’ safety it can be said that it refers avoidance of injury and harm and quality is all about
achieving the best possible health care outcomes (Jarrar and et.al., 2019). So, from this it can be
said that when healthcare professionals provide quality of healthcare that is safe, efficient, timely
and effective then it leads to improved health of patients. Improved patients health lead to safety
of care that can prevent them against any adverse event and negative impacts.
ACTIVITY 3
Adverse events and how frequent are these.
Adverse events means it is type of medical occurrence in patients or in clinical subject for
the investigation along with the pharmaceutical products which might be not cause any causal
relationship with having the better treatments (Schoenfeld and et.al., 2020). This also means that
while by having the negative impact on the patients who are admitted in the hospital as due to
having some wrong medicines dose to them due to which they have been caused the adverse
events in health care. Here are some frequently :
Adverse event Frequency Negligence

Occurred and discovered
during hospitalization
647 [50.6] 156 [51.0]
Occurred during index
hospitalization and discovered
during the patients out
78 [6.1] 7 [2.3]
Occurred during the
hospitalization and discovered
subsequently.
67 [5.2] 19 [6.2]
Types of Adverse events.
While by having looking for the hospital in adverse events as staff do not have time and
staff also believe that reports will only lead to improved their patients and also make sure about
their lack of understanding in the reports (Laatikainen, 2020). This might be also involved the
their cost being more to Medicare and protect over their patients in hospital.
Aged care setting the cognitive and physical that might be functional decline along with
this old age people are vulnerable for experiencing the adverse events. This could be a be
forestalled through screening and early ID of the components that put more seasoned individuals
in danger. As Adverse event in primary care incorporate both those subsequent from preventable
blunders or botches and inescapable occasions. Despite the fact that hazard and vulnerability in
medication block total end of iatrogenic illness, a superior understanding of the nature and
reasons for unfavourable occasions is important to decrease their event and breaking point their
mischief
Preventable and non-preventable adverse events.
Prescription wellbeing research and clinical drug store practice today is principally
cantered around overseeing preventable unfavourable medication occasions (Russom and et.al.,
2020). Determinants of both Preventable and non-preventable unfriendly medication responses
have been distinguished. In any case, moderately little is known on the cover between these
determinants and the equilibrium of preventable and non-preventable damage inpatients
experience in current mechanized medical clinics. No there is no preventable adverse events.

Reasons for distinction made between the systems and individual factors that are contributing to
adverse events.
The information and abilities that medical services suppliers create preceding work
through certify preparing programs is central to their capacity to play out their work.
Simultaneously, organism factors, for example, weakness coming about because of extended
periods of time and stress can impact the capacity of suppliers to apply their particular
information ideally (Gomolka and et.al., 2020). At the point when framework execution is
underneath some predetermined norm, an exertion is made to back-track the chain of occasions
and conditions to discover the causes. How far back to go or when to stop are open inquiries, the
responses to which are probably going to shift among various examiners.
ACTIVITY 4
Factor of adverse events and which of them are systems or individual factors
External environment factor that have been basically used for the systems for having the
knowledge about the some basis demographic and some about the technology which have been
used for the people (Furukawa and et.al., 2020). Management can be used for the individual
factor while through which that could keep the people and other staff more safe for having their
better treatment.

Figure 1Contributing Factors to Adverse Events in Health Care
Sources : Contributing Factors to Adverse Events in Health Care, 2018
Causal and contributing factors classified as system or individual factor.
Human components order structures can be utilized to recognize causal variables of
clinical antagonistic occasions. In any case, this survey proposes that current structures are
assorted, restricted in their ID of the setting of human blunder and have helpless unwavering
quality when utilized by various people (Kara, 2020). The capacity of human elements grouping
structures to give data on explicit causal components for an antagonistic occasion empowers the
focal point of preventive consideration on zones where upgrades are generally required.
The problems identified during the inquiries but not identified through Accreditation.
Accreditation surveys evaluate "quantifiable" execution, or ability to perform, against
foreordained and express principles and different partners have delivered. Results may
incorporate proposals for ceaseless improvement of security and quality in the training. The
accreditation cycle accepts that the design and activity of practices fundamentally impact results
for patients. has highlights that make it desirable over officials, specialist co-ops, safety net
providers, and payers just as beneficiaries of administrations for other assessed approaches
(Grabs, Auld and Cashore, 2020). One of these strengths can be the completeness and variety of
the assessment, the similarity of appraisal techniques with the particular idea of the wellbeing
framework, thoughtfulness regarding advancement as the primary target of assessment, and the
utilization of master evaluators. The examinations show the positive effect of accreditation in
upgrading adequacy, effectiveness, quality, wellbeing, authority, collaboration, and
correspondence, just as fulfilment and specialist co-ops.
Health and aged care are those harm to be susceptible.
Wellbeing dangers can now and then be confounding, yet they're essential to
comprehend. Knowing the dangers to many family and that can help discover approaches to keep
away from medical issues. It can likewise hold you back from worrying over far-fetched dangers.
Knowing the dangers and advantages of a clinical treatment can help PCP settle on educated
choices (Natarajan and et.al., 2020). A wellbeing hazard is the opportunity or probability that
something will hurt or in any case influence wellbeing. Hazard doesn't imply that something

terrible will occur. It's simply a chance. A few qualities, called hazard factors, influence whether
wellbeing chances are high or low.
Public inquiries are achieving the long term improvement in the quality and health services.
As the staff working are health care they are mostly influenced by the improving the
quality and other health services while through which they can also make sure about their
various strategies which are must be important for their patients (Silliman, Edwards and Johnson,
2020). While by having the public inquiries that could keep the health care developed and also
make sure to them how to improve the health care for keeping the patients safety.
ACTIVITY 5
The impact of organizational culture on health care quality and safety.
Authoritative culture creates its effect on hierarchical design both through its plan and its
execution. Hierarchical culture understands its sway on melding hierarchical construction
through shaping the interpretative plans of the top administration, which chooses the
authoritative design model. Some staff groupings may dominate at articulating and ordering
alluring qualities and practices, which might be useful to hierarchical objectives; for instance,
expert groups or focuses of greatness (Mannion, 2018). Less supportively maybe, different
subgroups may effectively attempt to subvert changes advanced from outside sources (regularly
understood as nonconformities). Regardless of whether such nonconformities reflect
inappropriate protection from change or a more fitting guard of suffering qualities might be
difficult to recognize and relies upon both viewpoint and setting.
The type of cultural supports that delivery for high quality and safe care.
Clinicians and staff are gotten some information about parts of their group, work region,
or emergency clinic, for example, correspondence about security risks, straightforwardness,
collaboration, and administration. Since environment is characterized as a trait of a group or
gathering, singular reactions to study things are typically amassed to frame unit-, office , or more
significant level scores (Buljac-Samardzic, Doekhie and van Wijngaarden, 2020). The part of
medical services associations is particularly significant in a learning medical care framework, on
the grounds that hierarchical variables an affect care quality and patient results. One
investigation tracked down that high-performing associations in cardiovascular failure care, as

estimated by improved death rates, for the most part had highlights like great correspondence
and coordination, shared qualities and culture, and involvement in critical thinking and learning.
A safety culture
It is the part of Joint Commission accreditation manuals characterizes security culture as
the result of individual and gathering convictions, values, perspectives, insights, skills, and
examples of conduct that decide the association's obligation to quality and patient wellbeing
(Gambashidze, 2020).
The person centred care integrated to safety culture.
The security culture has as of late pulled in the consideration of medical services
associations. Thinking about the significance of the jobs of medical attendants as to patient
security, their insight and encounters of the difficulties that impact patient wellbeing society can
work with the turn of events and execution of better methodologies (Rosa, Ferrell and Wiencek,
2020). The point of this investigation was to investigate the medical attendants' encounters of the
difficulties impacting the execution and incorporation of wellbeing society in medical care.
ACTIVITY 6
Clinical governance
Clinical governance can be defined as a framework that makes NHS organizations
accountable for improving quality of care as well as safeguarding high standard of care (Veenstra
and et.al., 2017). It also leads a process and activities in which NHS organizations need to make
a workplace where clinical care can be flourished.
Importance of clinical governance in health and aged care organizations
The main aim of clinical governments in age care organizations is to help all professionals in
providing safe, qualitative clinical care to patients and protecting themselves against lawsuits and
negative impacts of poor quality care. This system make accountable to such organizations
towards providing better healthcare services that does not have adverse impacts or also do not
lead to adverse event. It refers set of leadership behaviours, policies, responsibilities and
relationships that is vital for providing better care to patients with ageing population and protect
them against discrimination. Overall, it can be said that it leads to good clinical outcomes for
each service user.

Common elements of clinical governance frameworks
Clinical governance framework has 5 common elements and components that can make
professionals able to provide better healthcare to patients and improving their health such as:
Governance, leadership and culture: It is the main element according to which, all
healthcare professionals need to make working environment a place where all doctors and
professionals can work in an effective manner with using appropriate leadership.
Patients’ safety: It is another main component that professionals require to focus the
most while providing healthcare services to them. They need to think about patients safety and
accordingly they need to choose interventions (Kwedza and et.al., 2017).
Safe environment: It is important for professionals to provide safe environment to
patients where they can feel safe and for this they need to comply with anti discrimination laws.
Clinical performance: Focusing on medical practices and clinical procedures leads to
clinical performance. It is important for all to make sure that they are providing healthcare
services with concentration and with consciousness.
Partnership with consumers: Engaging patients and making them feel valued by
providing fair treatment is another element that can help in getting positive outcomes.
Barriers that need to be addressed for successful clinical governance
There are some areas that need to be focused the most for making clinical governance
successful such as: Improving inter-professional relations, training to all workers regarding
leadership and governance, improving working environment for increasing staff retention rate.
By making use of appropriate strategies and legislations all barriers can be decreased.
CONCLUSION

From the above report it had been concluded that quality management seems to be
important for having the health care system along with this also make sure about the various
thing for having the better development. In having the health care quality that could keep the
patients with having the better communication also makes sure about the communication and
help for solving the issues what they are facing. Safety culture also play important for having
their organization to be well-developed and make their patients to be safe more and more at the
hospitals.

REFERENCES
Books and journals
Buljac-Samardzic, M., Doekhie, K.D. and van Wijngaarden, J.D., 2020. Interventions to improve
team effectiveness within health care: a systematic review of the past decade. Human
resources for health. 18(1). pp.1-42.
Furukawa, M.F. and et.al., 2020. Electronic health record adoption and rates of in-hospital
adverse events. Journal of patient safety. 16(2). pp.137-142.
Gambashidze, N., 2020. Measuring Patient Safety Culture in Hospitals.
Gomolka, M. and et.al., 2020. Potential screening assays for individual radiation sensitivity and
susceptibility and their current validation state. International journal of radiation
biology. 96(3). pp.280-296.
Grabs, J., Auld, G. and Cashore, B., 2020. Private regulation, public policy, and the perils of
adverse ontological selection. Regulation & Governance.
Jarrar, M.T. and et.al., 2019. Hospital nurse shift length, patient‐centered care, and the perceived
quality and patient safety. The International journal of health planning and
management. 34(1). pp.e387-e396.
Kara, S., 2020. Prospective Visual Arts Teachers' Innovation Skills and Attitudes towards
Computer Assisted Instruction. International Journal of Technology in Education and
Science. 4(2). pp.98-107.
Kilbourne, A.M. and et.al., 2018. Measuring and improving the quality of mental health care: a
global perspective. World psychiatry. 17(1). pp.30-38.
Kwedza, R.K. and et.al., 2017. Perspectives of rural and remote primary healthcare services on
the meaning and goals of clinical governance. Australian journal of primary health. 23(5).
pp.451-457.
Laatikainen, O., 2020. Medication-related adverse events in health care (Doctoral dissertation,
Dissertation study. Acta Universitatis Ouluensis. D, Medica).
Maijala, R. and et.al., 2018. Successful implementation of lean as a managerial principle in
health care: a conceptual analysis from systematic literature review. International journal
of technology assessment in health care. 34(2). p.134.
Mannion, R. and Davies, H., 2018. Understanding organisational culture for healthcare quality
improvement. Bmj, 363.
Natarajan, R. and et.al., 2020. Environmental exposures during puberty: Window of breast
cancer risk and epigenetic damage. International journal of environmental research and
public health. 17(2). p.493.
Power, K., 2019. Improving Flow in Large Software Product Development Organizations–A
Sensemaking and Complex Adaptive Systems Perspective. NUI Galway, Galway.
Rosa, W.E., Ferrell, B.R. and Wiencek, C., 2020. Increasing critical care nurse engagement of
palliative care during the COVID-19 pandemic. Critical Care Nurse. 40(6). pp.e28-e36.
Russom, M. and et.al., 2020. Intravenous ranitidine injection and risk of cardiac arrest:
Medication errors. International Journal of Risk & Safety in Medicine, (Preprint). pp.1-7.
Schoenfeld, S.R. and et.al., 2020. Diagnosis and Management of Rare Immune‐Related Adverse
Events. The oncologist. 25(1), p.6.
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Silliman, B., Edwards, H.C. and Johnson, J.C., 2020. Long-term effects of youth work
internship: The Project Youth Extension Service approach. Children and Youth Services
Review. 119. p.105436.
Veenstra, G.L. and et.al., 2017. Rethinking clinical governance: healthcare professionals’ views:
a Delphi study. BMJ open. 7(1).
Online
Carayon, P., 2018. Contributing Factors to Adverse Events in Health Care. [Online]. Available
through: <https://www.researchgate.net/figure/Contributing-Factors-to-Adverse-Events-
in-Health-Care_fig2_49843292>
Mannion, R., 2018. Understanding organisational culture for healthcare quality improvement
[Online]. Available through: <https://www.bmj.com/content/363/bmj.k4907>
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