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Journal of the Academy of Hospital Administration

Vol. 15, No. 1 (2003-01 - 2003-06)

Editorial

The last decade has witnessed a revolutionary array in health care dimensions. Terms like "Total Quality Management", "ISO-9000", Continuous Quality Management", Reengineering" Benchmarking and Accreditation have embraced and got incorporated in the delivery of health care services. Globalisation, economic liberalisation, privatization of health services, patients enhanced awareness and expectations from providers of health care have made "Quality" an inseparable part of the health care delivery system.

To achieve quality is thus an essential ingredient and to formulate, evaluate standards as per predetermined objectives is a requisite which has become universally applicable to all health care institutions.

Total Quality Management (TQM) and Accreditation are two main strategic essentials which have to be initiated, evolved and sustained in all health care institutions. These are imperative managerial tools to successfully function a complex, matrix and a multidisciplinary institution i.e. the modern hospital.

Quality is not the end, it is a means to an end. Quality is not an absolute standard but must be worked at and consciously achieved. Quality in health care institutions is different from other organizations since the product i.e. health care is a multifaceted and multidimensional product and it delivered personally to the customer. Interaction between the provider and consumer significantly affects perception of quality.

TQM is a philosophy as well as a set of guiding principles and practices that represent the foundations of a continuously improving organization. It integrates fundamental management techniques, existing improvement efforts, futuristic quality plans, innovations and their successful implementation.

In the management of any type of system, success can most readily be attained if appropriate goals are first established. The development of appropriate hospital standards provides these goals. Hospital administrators may then focus an attaining levels of care, that although challenging are achievable. With the availability of standards, managers are less likely to become solely occupied by day-to-day problems and more likely to place some effort in a proactive search for institutional improvement.

A successful accreditation programme is educational in nature rather than punitive. The standards that are developed should facilitate improvement in quality of care, must be realistic and achievable within the available resources.

The standards used in accreditation programmes previously focused on structural evaluation but now attention is being given also to outcome evaluation. Accreditation programmes are operated to ensure that good quality services are provided by health institutions, their evaluation standards contain all the components of quality care. Modern accreditation programmes contain all aspects of the three components of quality care i.e. structure, process and outcome.

A modern hospital is a matrix organization, an amalgam of human resources, architecture wonders and technological advancement. Traditional Quality Assurance efforts are focused on retrospective review of documented patient care mainly in form of conventional medical audits. Outcome in the form of patient review are not included in these audits. TQM focuses on all the facets of effectiveness and efficiency in an organization. In traditional Quality Assurance, effort is to be achieve local or national standards, however in TQM attempts are also made to improve upon these standards e.g. turnaround time in a particular hospital"s emergency department from patient arrival to disposal is 20 minutes. A preliminary analysis of registration of the patient by resolving this turn around time may be decreased to 18 minutes. Traditional Quality Assurance terminates here. However, TQM process will dwell further and it may reveal inadequate nurse staffing as one more component for the delay. Hence a further reduction in the turn around time may be achieved.

The provision of health care services at the highest possible level of quality should be a common goal of all health care institutions. Health care administrators must look globally, since quality will be a differentiator in assessment of organizations.

It is essential to recognize that quality is a systematic consistent and balanced game plan, not just something extraneous in health care. TQM and Accreditation are not mere buzzwords but are extraordinary management tools for organization including health care institutions to survive and thrive in an era of globalization, liberalization and privatization. It must however, be realized that technologies, tools and standards are not necessarily transplantable. Some need modifications and then may be adopted, however, some may not be adaptable at all.

Application of TQM and adoption of Accreditation are the right steps, in the right direction while embarking on the arduous road of quality health care provisioning for all in the millennium.

A. Chakravarti

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