Total Quality Management (TQM)

It is an integrative philosophy of management for continuously improving the quality of

products and processes.
It functions on the premise that the quality of products and processes is the responsibility
of everyone who is involved with the creation or consumption of the products or services
offered by an organization.
In other words, TQM capitalizes on the involvement of management, workforce, suppliers,
and even customers in order to meet or exceed customer expectations.

Nine common TQM practices

cross-functional product design

process management
supplier quality management
customer involvement
information and feedback
committed leadership
strategic planning
cross-functional training
employee involvement.

Core concepts in implementing TQM

This a set of management practices to help companies increase their quality and productivity

Create constancy of purpose for improving products and services.

Adopt the new philosophy.
Cease dependence on inspection to achieve quality.
End the practice of awarding business on price alone; instead, minimize total cost by
working with a single supplier.
Improve constantly and forever every process for planning, production and service.
Institute training on the job.
Adopt and institute leadership
Drive out fear.
Break down barriers between staff areas.
Eliminate slogans, exhortations and targets for the workforce.
Eliminate numerical quotas for the workforce and numerical goals for management.
Remove barriers that rob people of pride of workmanship, and eliminate the annual rating
or merit system.
Institute a vigorous program of education and self-improvement for everyone.
Put everybody in the company to work accomplishing the transformation.

Principles of TQM

Quality can and must be managed.

Everyone has a customer to delight.
Processes, not the people, are the problem.
Every employee is responsible for quality.
Problems must be prevented, not just fixed.
Quality must be measured so it can be controlled.
Quality improvements must be continuous.
Quality goals must be based on customer requirements.

A very simple model of TQM consists of the following steps:

The company reviews the needs of its customers and if these are being delivered by the
company;
 The company plans the activities needed (both day-to-day and long-term activities) to
meet these customer needs;
The company establishes and stabilizes the processes required to deliver the products and
services needed by the customer;
The company implements systems to further improve its processes, products, and
services.

(Note that Steps 1-4 above constitute a cycle, and may be iterated indefinitely for continuous
improvement)

Total Quality Management (TQM) in Nursing Care

INTRODUCTION

Quality refers to excellence of a product or a service, including its attractiveness, lack of

defects, reliability, and long-term durability.
Quality assurance provides the mechanisms to effectively monitor patient care provided
by health care professionals using cost-effective resources.
Nursing programmes of quality assurance are concerned with the quantitative
assessment of nursing care as measured by proven standards of nursing practice.
Quality assurance system motivates nurses to strive for excellence in delivering quality
care and to be more open and flexible in experimenting with innovative ways to change
outmoded systems.
Florence Nightingale introduced the concept of quality in nursing care in 1855 while
attending the soldiers in the hospital during the Crimean war

CONCEPT OF QUALITY IN HEALTH CARE

Quality is defined as the extent of resemblance between the purpose of healthcare and
the truly granted care (Donabedian 1986).
Quality assurance originated in manufacturing industry to ensure that the product
consistently achieved customer satisfaction.
Quality assurance is a dynamic process through which nurses assume accountability for
quality of care they provide.
It is a guarantee to the society that services provided by nurses are being regulated by
members of profession.
Quality assurance is a judgment concerning the process of care, based on the extent to
which that cares contributes to valued outcomes. (Donabedian 1982).
Quality assurance as the monitoring of the activities of client care to determine the
degree of excellence attained to the implementation of the activities. (Bull, 1985)
Quality assurance is the defining of nursing practice through well written nursing
standards and the use of those standards as a basis for evaluation on improvement of
client care (Maker 1998).

APPROACHES FOR A QUALITY ASSURANCE PROGRAMME

Two major categories of approaches exist in quality assurance they are:

o 1.General
o 2.Specific

A. General Approach
It involves large governing of official bodys evaluation of a persons or agencys
ability to meet established criteria or standards at a given time.

1) Credentialing
- formal recognition of professional or technical competence and attainment of
minimum standards by a person or agency

Credentialing process has four functional components

 To produce a quality product
To confer a unique identity
To protect provider and public
To control the profession.

2) Licensure

- Individual licensure is a contract between the profession and the state, in

which the profession is granted control over entry into and exists from the
profession and over quality of professional practice.

The licensing process requires that regulations be written to define the scopes and limits
of the professionals practice.
Licensure of nurses has been mandated throughout the world by laws and regulations.

3) Accreditation

ISO International Organization for Standardization

JCI Joint Commission International

NABH National Accreditation Board for Hospitals and Healthcare Providers

(India)

Accrediation Canada

NAAC National Assessment and Accreditation Council (India)

4) Certification

Certification is usually a voluntary process with in the profession.

A persons educational achievements, experience and performance on examination

are used to determine the persons qualifications for functioning in an identified
specialty area.

B. Specific approaches

1) Peer review

Peer review is divided in to two types.

1. The recipients of health services by means of auditing the quality of

services rendered.
2. The health professional evaluating the quality of individual performance.

2) Standard as a device for quality assurance

- Standard is a pre-determined baseline condition or level of excellence that

comprises a model to be followed and practiced. The ANA standard for practice
include:

Standard 1: The collection of data about health status of the patient is

systematic and continuous. The data are accessible, communicative, and
recorded.

Standard 2: Nursing diagnoses are derived from health status data.

 Standard 3: The plan of nursing care includes goals derived from the nursing
diagnoses.

Standard 4: The plan of nursing care includes priorities and the prescribed
nursing approaches or measures to achieve the goals derived from
the nursing diagnoses.

Standard 5: Nursing actions provide for patient participation in health

promotion, maintenance, and restoration.

Standard 6: Nursing actions assist the patient to maximize his health

capabilities.

Standard 7: The patients progress or lack of progress towards goal

achievement is determined by the patient and the nurse.

Standard 8: The patients progress or lack of progress towards goal

achievement directs re-assessment, re-ordering of priorities, new
goal setting, and a revision of the plan of nursing care.

3) Audit as a tool for quality assurance

Nursing audit may be defined as a detailed review and evaluation of

selected clinical records in order to evaluate the quality of nursing care and
performance by comparing it with accepted standards.

QUALITY ASSURANCE PROCESS

1. Establishment of standards or criteria

2. Identify the information relevant to criteria
3. Determine ways to collect information
4. Collect and analyze the information
5. Compare collected information with established criteria
6. Make a judgment about quality
7. Provide information and if necessary, take corrective action regarding findings of
appropriate sources
8. Determine ways to collect the information

CONCLUSION

To ensure quality nursing care within the contemporary health care system, mechanisms
for monitoring and evaluating care are under scrutiny. As the level of knowledge increases for
a profession, the demand for accountability for its services likewise increases. Individuals
within the profession must assume responsibility for their professional actions and be
answerable to the recipients for their care.

As profession become more interdependent, it appears that the power base will become
more balanced, allowing individual practitioners to demonstrate their competence and
expertise. Quality assurance programme will helps to improve the quality of nursing care and
professional development.

References:
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