Total Quality Management Strategies for Healthcare Quality Improvement

This report delves into the application of Total Quality Management (TQM) within the healthcare sector, emphasizing the critical need for improving organizational culture, enhancing patient safety, and preventing medical errors. It uses the case study of a significant medical error involving infant twins at Cedars-Sinai Hospital in 2007 to highlight the importance of effective educational training programs, collective learning, and the integration of relevant technologies such as iris scanners, fingerprint scans, barcode, and RFID tags. The report advocates for strategic management of stakeholders, promoting educational culture within hospital environments, and structural reorganizing to systematically resolve cultural problems and improve healthcare quality and services. It concludes that focusing on physician behavior is a starting point for elaborating the behavior of all stakeholders within the organization to promote quality of healthcare.

Total Quality Management

Table of Contents
Total Quality Management..............................................................................................................0
Introduction......................................................................................................................................2
Improving organisational culture and safety...................................................................................2
Role of interpersonal communication in preventing recurrences of medical errors........................3
Relevant Technologies.....................................................................................................................5
Iris and fingerprint scan for patient’s identity.............................................................................5
Barcode and RFID tags................................................................................................................6
Recommended Actions....................................................................................................................6
Conclusion.......................................................................................................................................7
Reference.........................................................................................................................................9
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Introduction
There has been a very little evidence to date of what should be done to improve the
organisational culture in hospital and what initiatives would be the most effective and efficient
way in order to develop the quality of healthcare system in hospital setting (Scott, Mannion,
Davies & Marshall, 2018). One of the main challenges every hospital is facing nowadays is to
identify an initiative which would efficiently remove the problem of deficient culture of the
hospital and inadequate organisational resources that are needed to improve the quality of
healthcare. The term organisational culture includes the behaviour of individuals within the
organisation and how those individuals pay attention and respond to critical situations. There are
many medical institutions in USA which did research on the relationship between the safety
issues of the patient, the well being of the physician and organisational culture (Hall, Johnson,
Watt, Tsipa, & O’Connor, 2016). Over time the problems of hierarchical bureaucracies appears
in an organisational culture. When these types of problem appear, people within the organisation
do not respond or accept the changes, rather they rely on the existing set of routines.
Improving organisational culture and safety
When an authority of the organisation is trying to implement an initiative in order to improve the
culture of the organisation, it should focus on improving the impact of the changes in the role of
a physician and other workers in the hospital. In hospital, physician Burnout is the main threat to
the problem of organisational culture. Burnout is a serious case of emotional fatigueness and
exhaustion. When a person is so much involved with the emotionally demanding atmosphere for
a long period of time, it can cause depersonalization. It can also cause when the chances of
personal accomplishment is reduced. Physician Burnout increases the chances of making
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mistakes as it it reduces the ability of a physician who is required to provide the best quality of
healthcare to the patients (Shanafelt & Noseworthy, 2017). It creates a situation which is directly
linked to the working condition of a physician and and the experience of a patient he or she gets
while receiving a treatment from the hospital. So, the question is how organisational culture
impacts the physician and the other workers who are working within a specific working
condition that causes burnout and stress. Every hospital authority should figure out an effective
initiative in order to promote quality of healthcare by considering significant organisational and
cultural changes in hospital environment and those issues that are embedded with the success or
the failure of the organisation and the way it causes burnout to the physicians and other workers
(Moss, Good, Gozal, Kleinpell, & Sessler, 2016).
Role of interpersonal communication in preventing recurrences of medical
errors
There are many cases in America where more people are dying due to medical mistakes rather
than from cancer AIDS or other disease. It is just a matter of time when such major health issues
will touch every single American lives at some point. And something like that happened in 2007
when when such medical mistake had almost taken the lives of infant twins, the children of
Dennis and Kimberly Quaid. The twins had a serious staph infection and the parents were asked
by doctor to take the newborns to Cedars-Sinai Medical Center. On the second day at the
hospital the parents were told that the childrens were doing fine. But in the next day when they
visited the hospital, they found out that their children was in real danger. The childrens were
prescribed to be given heparin which would keep their IV lines clear and remove blood clots. But
the nurses accidently overdosed the children as they were supposed to get 10 units of heparin but
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they got 1000 units of heparin which has turned their blood into water. In such scenario effective
educational training program is urgently needed in order to educate the nurses and the other
workers in such critical situation. Hospital authority can organise education and training program
by bringing a team of people who would be able to profile educational assistance to those
workers or assist them in finding solutions. Collective learning place a big role in order to
provide quality and safety measures in critical hospital atmosphere. The main objective is how to
make make a kind of hospital atmosphere which promotes learning through the process of
leadership. In order to provide safety and quality, the working culture of hospital atmosphere
should be built on the theory of experimentation, improvisation, exploration, learning from
mistakes etc (Graban, 2016). The learning atmosphere should be very supportive and and it
should be characterized by providing psychological safety to the workers of the organisation.
Difference of opinion new ideas and team autonomy should be appreciated under the working
condition of hospital environment. Learning atmosphere under the working condition of a
hospital environment should also focus on improving the impact of leadership behaviour. The
hospital authority should also take initiatives that support improvements by providing access to
information and knowledge, resources strategic actions and by developing the working culture. It
is important to implement the process of of collective learning in the organisational culture of the
hospital as it allows an individual to interpret and analyse organisational experience
interactively. Leadership and other environmental factors have a great influence over the
atmosphere that promotes collective learning which in turn brings improvement and desired
outcome (Lalleman, Smid, Lagerwey, Shortridge-Baggett, & Schuurmans, 2016). Hospital
authority would be able to reduce medical errors by promoting and environment that supports
collective learning and through interpersonal communication and collaboration.
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Relevant Technologies
The story of medical error Dennis and Kimberly Quaid’s infant twins experienced at Cedars-
Sinai Hospital in 2007 has changed the course and the working culture of the hospital. First the
pharmacist made the mistake by putting the larger bottle of heparin in the same bin along with
the bottles of small dose heparin. There was the high time in order to raise the public awareness
and take some initiatives to keep the records of the patience secured with computerized and
barcoding Technology. That incident was the wake up call for for the healthcare system of
America. The hospital authority has invested more than 100 million US dollar in some new
technologies in order to make sure that this type of medical mistake would never happen again.
The hospital authority has installed a computerized barcode system in order to keep the record of
the patient secure and to reduce the human error. There are many cases in America where more
people are dying due to medical mistakes rather than from cancer AIDS or other disease. It is just
a matter of time when such major health issues will touch every single American lives at some
point. And something like that happened in 2007 when when such medical mistake had almost
taken the lives of infant twins, the children of Dennis and Kimberly Quaid. After that incident
many Technologies have been emerged since that time that could have been impacted this case.
Iris and fingerprint scan for patient’s identity
Sometimes unconscious and heavily disoriented patients cannot answer to the questions of
medical practitioner and this is a very hectic task for the medical practitioners to determine who
the patient is and his or her medical condition. Sometimes patient don't want to disclose their
identity and medical condition in order to avoid criminal activity and health insurance frauds. In
order to get quality healthcare, a medical practitioner needs to know who the patient is and he is
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our her medical condition (Ragan, Johnson, Milton & Gill, 2016). Not knowing the identity of a
patient can cause medical errors. Now it has become very easy for the medical practitioner to
know a patient’s identity even without their cooperation. Because new technologies have been
invented such as iris scanner. When iris is scanned, every single detail found in the pattern of iris
is scanned by a system that scans through a video camera and infrared Technology. Iris scanner
has a special feature of having a mathematical and statistical algorithms which can be codes the
pattern and identifies The Identity of a person. In healthcare setting, this system can be used for
those patients who are in a really critical condition and can be very useful in order to prevent any
kind of potential drug interaction for allergies (Manit, Bremer, Schweikard & Ernst, 2017).
Barcode and RFID tags
These two technologies are being used for a long time in healthcare system. These technologies
are are combined with other Technologies like eMARS(electronic medication administration
records). In this technology, the patients are given a barcoded wristband with an eMARS
Technology. Medical practitioner scans the wristband in order to know if the patients are getting
the right medication and drug (Harding, Suhr, & Allen, 2015).
Recommended Actions
Every organisation is largely influenced by the stakeholders and the success or the failure of an
organisation also influences the stakeholders. Managing stakeholders is one of the most
important parts of managing an organisation. There are two types of stakeholders i.e primary
stakeholders and the secondary stakeholders (Bridoux & Stoelhorst, 2014). Primary stakeholders
are directly associated with the ongoing projects of an organisation and those who are in a
position to influence the progress of the project while secondary stakeholders are not directly
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associated with the projects of an organisation and and those who have a very informal
relationship with the organisation. For the success of an organisation it is important to maintain a
good relationship with the stakeholders as they are the ones who can influence the onprojects of
the organisation (Sweeney, Clarke & Higgs, 2018). The authority of an organisation should
always try to implement it strategic management as a part of managing stakeholders in order to
maintain a mutual benefit between them. If the relationship between the organisation authority
and its key stakeholders strong that relationship would allow the organisation to cope with
uncertain environment and unstable situations. Strong relationship with the stakeholders always
contribute to the organisation in shaping vision, executing necessary plans etc. In hospital and
healthcare system, there is a different form of stakeholders involvement. Hospital authority
always collaborates with insurance companies and with other hospital and hospital authority
always invests in the stakeholders. In healthcare system, stakeholders are involved just to
increase the efficiency and effectiveness (Busse, Aboneh & Tefera, 2014). The medical staffs of
a hospital are considered as internal stakeholders. It is important to make sure that the hospital
authority is promoting educational culture inside the working atmosphere of the hospital which
would in turn lead to effective and efficient healthcare and services to the patients and allow
external stakeholders to become more proactive to support ongoing plans and projects.
Conclusion
This article deals with the solution that every hospital authority should find and effective and
efficient initiative that would ultimate resolve the cultural problems within the organisation
systematically, and in order to achieve structural reorganizing within the organisation proper
strategic planning is required. This article is not implying that the behaviour of the physician is
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the only perspective that requires consideration. Rather it is implying that the physician holds a
significant role in the organisational culture of a hospital and examining the behaviour of the
physician is the starting point in order to elaborate the behaviour of all the stakeholders within
the organisation culture of a hospital. Every hospital authority should figure out an effective
initiative in order to promote quality of healthcare by considering significant organisational and
cultural changes in hospital environment and those issues that are embedded with the success or
the failure of the organisation and the way it causes burnout to the physicians and other workers.
8

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