Total Quality Management Report: Novena Medical Center

This report, prepared as part of the BUS363e Total Quality Management course, analyzes the TQM practices at Novena Medical Center in Singapore. The report evaluates the hospital's current performance across various dimensions, including leadership, strategy, and people management, based on a provided TQM framework. It identifies key customers, suppliers, and competitors, providing a comprehensive overview of the hospital's operational environment. Furthermore, the report pinpoints areas for improvement, such as reducing patient waiting times and enhancing the quality of MRI scans. The application of Lean Six Sigma methodologies, including fishbone diagrams and process flow maps, is proposed to address these issues. The report details a project charter for implementing these improvements, outlining objectives, scope, and potential benefits, aiming to enhance service delivery and customer satisfaction.

OPERATIONS 1
TOTAL QUALITY MANAGEMENT
Name of student
Name of institution
Name of instructor
Course code
Date

OPERATIONS 2
Section A: Question 1
(a) Novena medical centre
Novena is a leading medical Centre in Singapore that prides in offering high-quality
health services ("One of the Leading Clinics | Novena Medical Center Singapore", 2019).
Novena competes with private and public hospitals in Singapore such as John Hopkins, National
Neuroscience Institute and national skin cancer centre ("One of the Leading Clinics | Novena
Medical Center Singapore", 2019). Novena offers a range of health services including surgery,
blood tests, respiratory treatments, therapies, medical advice, X-rays and general medical
services. The hospital has assembled a team of highly trained and experienced employees to
deliver services to the customers. Moreover, the hospital has installed adequate capacities such
as surgery equipment, adequate nurses and doctors, recovery rooms, beds and ambulances.
Novena has executed many successful surgeries on patients, which has led to customer
trust and loyalty. Additionally, the ability to open up many branches within the country has
increased customer access to the hospital. Furthermore, to improve service delivery the hospital
has partnered with Universities and research institutions to assist in acquiring the best technology
("One of the Leading Clinics | Novena Medical Center Singapore", 2019). The technology has
led to various advances in the medical field such as the use of robotics in surgery. On the other
hand, the universities allow the hospital to acquire the best medical students for training and
recruitment. Therefore, Novena has successfully assembled a team of highly trained doctors,
nurses and other support staff.
(b) The key customers, suppliers and competitors
The main customers at Novena medical centre include both children and adults. The
children visit the pediatric centre while the adults visit the general medical centre. The customers
visit different hospital departments depending on the health issue diagnosed by highly trained

OPERATIONS 3
nurses. Additionally, the customers have a difference according to the mode of payment. The
differences entail public and private customers. Private customers include business persons and
people working in private companies and non-governmental organizations. On the other hand,
public customers include government employees and officials. The government pays for the
public customers’ health bills ("One of the Leading Clinics | Novena Medical Center Singapore",
2019).
Novena relies on suppliers such as Scanmed to deliver medical equipment such as X-ray
machines and other necessary surgery tools. Scanmed has signed a long-term contract with
Novena to supply high-quality health equipment. The supplier has the duty to supply products in
time to avoid shortage and delays in patients’ diagnosis and surgery.
Moreover, Novena medical centre faces competition from various players in the medical
field. The players include the John Hopkins, National neuroscience institute and the National
skin cancer centre ("One of the Leading Clinics | Novena Medical Center Singapore", 2019).
Additionally, the hospital also faces competition from government hospitals that offer subsidized
services. The medical industry has encountered an increase in competition over time especially
with the current technological breakthroughs in medicine. Novena has to ensure that the
customers get high-quality services to ensure survival in the long-term. Therefore, Novena has
taken various steps towards customer satisfaction such as charging affordably for high-quality
services. The move has enabled the hospital to compete with government hospitals that offer
similar prices at reduced prices. Likewise, Novena has engaged in extensive medical research to
come up with better medicines. For example, the company has developed new technology to deal
with cancer, which has attracted a large number of customers thus beating the competition.
(c)

OPERATIONS 4
S/N Statement 5 4 3 2 1 Justification
on the
rating
assigned
Countermeasure
s
1 Leadership:
Senior leaders have
developed a clear vision
and mission, which are
clearly communicated to its
stakeholders.
* Novena
employees
understand
the
objectives
and work
towards the
achievement.
Novena should
increase
surbordinate
employees’
engagement in the
development of
strategies.
2. Strategy:
The organisation develops
strategies to achieve
organisational goals.
* Novena has
set the goal
of becoming
the number
one medical
centre in the
country. To
achieve the
goal, Novena
invests in
research and
development
to ensure
customer
satisfaction.
The organization
does not monitor
and evaluate the
strategy, which
could cause
failure.
3. People
The organisation
develops and aligns
Human Resources plans
to achieve organisational
goals.
* Novena
constantly
trains
employees to
equip with
current
medical
knowledge.
Novena should
increase
employee pay to
ensure motivation
towards the
achievement of
objectives.
4. Knowledge
The organisation uses
benchmarking to improve
organisational
performance.
* The
organization
sends
representativ
es to
different
countries
such as the
USA,
Germany and
China to
Novena should
ensure the
implementation
of knowledge
gained from the
benchmarking
activities.

OPERATIONS 5
learn ways of
improving
service
delivery.
Ratings:
5: Excellent
4: Very likely 3:
Likely
2: Sometimes 1:
Minimal
(Indicate each statement with a rating of between 1-5 using * or X)
Question 2
(a) Areas of improvement at Novena medical care
Novena medical centre can implement various improvements to the services offered to
patients. The areas of improvement include such as reducing the customer waiting time before
operations and improving the image quality of MRI scans. The two problems pose a challenge to
the hospital, which has resulted in customer dissatisfaction. Therefore, the hospital management
should come up with immediate measures to eliminate the problems. Novena medical centre
primarily deals with surgical issues, which calls for improvements in the quality of MRI images
and reduced waiting times (Lockwood, 2010).
Furthermore, poor quality MRI images could result in a wrong patient diagnosis that
could lead to fatal or expensive consequences. Additionally, the hospital could lose the operating
license due to failure to uphold quality health standard as required by health regulations.
(b) Application of lean six sigma to improving the quality of
MRI scans
The health industry has experienced an introduction to various imaging equipment each
year. The imaging equipment provides an upgrade to what was used previously and come with
advanced functionalities. Consequently, the machines give physicians and patients additional

OPERATIONS 6
confidence in the diagnosis. The new equipment poses an expense to the health centres due to the
need to dispose of the outdated equipment and replace with the new MRI scanners.
Novena health centre undertakes constant upgrades of MRI equipment to keep up with
competition and patients’ changing needs. However, Novena still experiences quality problems
in the images scans and diagnosis. The quality problems arise from other factors not associated
with MRI scanning machines (Vecchiato, 2012). The factors include such as the conditions of
processing, equipment calibration and the capabilities of the expert observing results. The factors
affect the quality of MRI images externally, which presents a challenge when determining the
cause of poor images and diagnosis. Therefore, the fishbone diagram, which is a six sigma tool
comes in handy.
The fishbone diagram could assist in identifying the root cause of the poor quality MRI
images and diagnosis (Fabricius & Cundill, 2014). The diagram lists down the various parties
and equipment used in the MRI scanning and diagnosis together with the deficiencies. The
deficiencies then lead to a result, which is poor images and diagnosis. The fishbone diagram
enables in identifying the deficiencies at each stage of image and diagnosis interpretation.
Therefore, Novena has the ability to tackle each part and make the necessary improvements.
The lean six sigma suggest various solutions to reduce the bias of image interpretation,
which results in poor diagnosis (Rentschler & Kirchner, 2012). The solutions include such as
giving additional training to the equipment users to increase knowledge of interpretation and
reduce errors. Additionally, performing constant repairs and maintenance to the equipment could
also reduce the chances of error. The quality details highlighted by the fishbone diagram allow
the quality department to come up with the root causes of the problems, which triggers the
process of improvement.

OPERATIONS 7
The application of six sigma in reducing patient waiting time
The other area that requires improvement is in decreasing patients waiting time at the
medical centre. The patients at Novena experience long waiting times in lines before seeing
practitioners. Additionally, the hospital takes a long period before releasing customer results for
laboratory tests. The delays give customers anxiety and a feeling of frustration, which sometimes
results in seeking medical attention from other hospitals. Consequently, Novena loses customer
loyalty and revenue when customers seek medical attention from other centres.
Novena has to address the quality problem in time before losing a large percent of the
market share and customer loyalty. The lean six sigma can assist in solving the delay problem
and introduce better procedures that satisfy customers with speed (Rist, Felton, Samuelsson,
Sandström & Rosvall, 2013). The hospital can use a process map to identify the various nodes of
customer interaction. The identification of nodes allows the quality team to identify the various
areas where the delay occurs. For example, the process flow chart shows the customer movement
from the arrival stage to check-out. The arrival stage involves welcoming at the reception,
diagnosis and allocation to the appropriate department for treatment. The process flow map
identifies the actual time spent by customers at various points, which helps in understanding
where customers experience delays. Additionally, the process flow map exposes the useless
activities that cause unnecessary delays at Novena medical centre.
Novena should focus on reducing the causes of delays exposed by the process flow map
(Sulistiyani, 2012). The actual examples of delays at the hospital include long registration
procedures at the reception, use of manual procedures to diagnose patients and an insufficient
number of medical practitioners. Therefore, Novena should solve the problems by taking actions
such as installing computerized medical diagnosis systems. Computerized diagnosis systems
assist in identifying medical issues within a short time and avoid error at the same time (Srinivas

OPERATIONS 8
Rao, 2012). The other solution includes employing more practitioners to reduce medical
practitioners’ work overload. Novena should also reduce the registration procedures at the
reception to ensure that customers check-in quickly without experiencing delays.
The fishbone diagram will also assist in reducing customer delays by identifying the root
cause of the delays. The fishbone diagram identifies the various parties and equipment used to
attend to the customers with the exact time spent by the customer at each point (Sax & Andersen,
2018). The identification of the root causes of delay assists Novena’s improvement department to
understand the process that requires attention. Therefore, Novena should attend to the processes
causing delay with effective remedies such as automating procedures, training employees and
eliminating useless procedures.
(b) Project charter for Novena lean six sigma
Project scope
Long customer waiting times at Novena hospital poses a challenge to operations and
customer satisfaction. The customers have to wait for long from check-in time to when a medical
practitioner gives attention. The customers feel frustrated, which has resulted in a reduction of
patients visiting the center. Novena’s quality department intends to solve the problem by
identifying the factors that cause delays and introduce better systems that will ensure quick
customer processing ("Management", 2016). Moreover, the customer delay problem has caused a
reduction in the number of customers served in a day. Consequently, the revenues have gone
down, which could lead to future financial problems.
Novena has appointed a consultancy team to identify the problems and come up with
solutions. The consultancy team has already prepared a budget and a timeline for delivering the
project. The projections show that the implementation of changes will lead to quick customer
processing and satisfaction (Leverington, Costa, Pavese, Lisle & Hockings, 2010). Therefore,

OPERATIONS 9
Novena should provide the necessary resources and cooperation to allow improvement of the
service delivery system.
Objectives
The objectives of the project include improving the speed of service delivery at Novena
hospital. The measure of service delivery improvement will happen by checking whether the
customers spend less time waiting for services. On the other hand, the project aims at reducing
useless activities at the hospital that cause unnecessary customer delay (Geldmann et al., 2015).
The elimination of unnecessary activities will result in customers spending lesser time and
reducing customer frustration.
Furthermore, the project aims at equipping the employees with better skills to serve the
customers better and faster. The training will include aspects such as customer relations, use of
computerized systems and error reduction (Flanigan, 2016). The training will allow the
employees to have a better understanding of operations, which will help in understanding
customer needs.
Moreover, the project team aims at achieving an increase in revenues arising from better
and speedy services. The project has projected an increase in revenues by 70% during the current
financial year. The projection states that with faster services that lack errors, more customers will
visit the centre (Corrigan, J. Robinson, Burgess, Kingston & Hockings, 2017). Additionally, the
elimination of errors will ensure that some resources do not go towards redoing tasks.
The other objective includes introducing lean six sigma tools such as the fishbone
diagram and the process map in operations (Cook & Hockings, 2011). The fishbone diagram will
enable the operations department to identify the root cause of problems in the process of service
delivery. On the other hand, the process map will assist in identifying bottlenecks in operation

OPERATIONS 10
and enable quick improvement. The six sigma tools will enable Novena to come up with quick
remedies for challenges in operations that cause customer delays.
Project assumptions
The project team has made various assumptions such as only the operations officers have
an understanding of the problems and can come up with solutions (Cabeza, 2013). The other
assumption includes that the consultancy team will come up with the best solution to the problem
facing the hospital operations. Finally, Novena’s management assumes that the allocated
resources will cater to the project requirements.
Risks facing the project
The project faces various risks such as a deficiency of resources in the future, which
could hinder the realization of the objectives (Bromiley, Rau & McShane, 2014). The other risk
includes installation of outdated computer systems due to the frequent and drastic changes in
technology. Additionally, Novena faces the risk of failing to address the exact problems that face
customer service.
Resource requirements
The project requires resources such as:
 People
 Shareholders
 IT experts
 Project managers
 Business analysts
 Executive management
 Chief finance officer

OPERATIONS 11
Time
The estimates show that the project will take two months to implement. Monitoring and
evaluation will begin after 2 months from project implementation.
Finances
The approved estimated budget for the service delivery system is 700,000 dollars.
Novena will understand the actual budget after the implementation stage.
Project milestones
 Approval of the project charter
 Project start-up meeting
 Finalizing requirements
 Development and design of the project
 Training of employees
 Installation of computerized systems
 Development of six sigma tools such as fishbone diagram and process maps
Project team duties and responsibilities
Team member Roles Responsibilities
Patrick Juan Service Manager Develop a service charter that
will reduce customer delay.
Mrs. Petra Sue IT manager Develop the computerized
customer service delivery
system.
James Allan Auditor Perform monitoring and
evaluation for the project.

OPERATIONS 12
Communication strategy
The project team will communicate through meetings where all team members and
stakeholders meet to discuss proceedings (Anthony & Shestackova, 2015). The meetings will
cover the milestones, budgets and changes in the project. Additionally, the team will use status
reports to give daily communications on the status of the project. The aim of communication is
to ensure that the concerned parties have adequate information about the project status.
(c) Identifying the root cause of problems using lean six sigma
Process mapping
Lean six sigma will assist in reducing delays at the hospital. Novena hospital will use the
fishbone diagram, process mapping and interrelationship diagram (Gillingham, 2012). The
hospital will begin with the process map to identify the various steps taken by a customer before
getting services. The process map will list the activities at each stage, the time taken and the
employees involved at each stage. The listing will assist to identify the unnecessary steps taken
by the customer from the check-in stage to check-out. The various stages that the process
diagram will list include patient check-in, first examination, additional tests, specialist
consultation and check-out after surgery. The identification of the time taken by patients at each
stage enables the hospital to come up with a solution for avoiding delays. To avoid delays,
Novena could increase the number of employees that serve customers to prevent overload on a
few attendants. The customers will always find an attendant ready to perform the required
actions such as registering, initial testing and allocation to a specialist. Additionally, the process
map will show a clear plan of activities for the patients at the hospital, which will prevent
confusion (Van Niekerk & Maharaj, 2011).