Total Quality Management in Health Care
Total Quality Management in Health Care
At The George Washington University Medical Center, in Washington, D.C., cancer patients used to wait 11 hours or more for chemotherapy treatments; today, the average wait is less than two hours. At Overlake Hospital Medical Center, near Seattle, a new fast-track system for handling emergency room cases gets people with simple injuries in and out the door in half an hour. In each case, the same quality-management techniques that have produced performance breakthroughs in other industries are being applied to hospital management, with encouraging results. Perhaps no American industry could benefit more from adoption of Total Quality Management (TQM) techniques than health care. Experts maintain that a huge portion of the nation's annual healthcare expenditures can be attributed to waste and ineffciency. Spending on health care nationwide last year hit a record $838.5 billion, equivalent to 14 percent of the nation's total economic output, according to the Commerce Department. Health plans purchased by businesses account for about one-third of total health expenditures. (Thareja 2008)
"The waste is astronomical," says A. Blanton Godfrey, chairman and CEO of the Juran Institute, a consulting firm based in Wilton, Conn. "At least 20 percent of the lab tests are unnecessary. Every infection is waste. Every complication after open-heart surgery is waste--and triples the bill." While health-care reform is a priority of the Clinton administration, congressional debate in the past has focused on overhauling the delivery system, making sure all Americans have access to affordable care. TQM would complement that effort by focusing on improving the processes involved in delivering quality service, often with the benefit of cutting costs.
"By reducing the number of infections, which means improved quality for patients, a hospital also saves a bundle of money," says Godfrey. "There are wonderful synergies. In many cases, high-quality care actually costs less." Although quality techniques have been applied for over a decade in manufacturing industries, TQM is a relative newcomer to hospital management. Interest in the idea increased in the late 1980s after 21 hospitals participated in a project designed to demonstrate the application of TQM to health-care delivery. The hospitals reported the results of their efforts in June 1988. An extended version of their reports was published in 1990 in a book titled Curing Health Care: New Strategies for Quality Improvement (Jossey-Bass).
Not all the hospitals produced success stories, but many did. Subsequently, more and more hospitals have decided to try quality-management techniques, though they remain the exception, not the rule. The George Washington University (GWU) Medical Center, for example, has successfully applied TQM techniques in a number of departments. Not long ago, patients often didn't get medicine delivered in a timely fashion. Prescriptions sometimes got lost. As a result, "there was a major war between nursing and pharmacy," says Roger Chaufournier, assistant vice president for quality. "It rivaled Desert Storm." (Paul 1998)
When an interdisciplinary TQM team of GWU staff members studied the problem, it found no one was at fault, ...