THE CURE

THE TOTAL QUALITY MANAGEMENT IN A

SUPERSPECIALITY HOSPITAL - MEDICA, KOLKATA

Under the guidance of

MS. DEBASRI DEY

Submitted By
SWASTIKA KUNDU
REGISTRATION NO: 1302003216
(A Report Submitted in Partial Fulfillment of the Requirements for the
Degree of Master of Business Administration in Operation management)
From
Center: SMU-DE, Basubir Foundation, 127-C, Raja S.C Mallick Road,
Kolkata 700 047
(LC CODE NO.: 01637)

DIRECTORATE OF DISTANCE EDUCATION

SIKKIM MANIPAL UNIVERSITY, SIKKIM

2014

1|Page

ACKNOWLEDGEMENT
I express my sincere gratitude to my respectful guide DEBASRI DEY, Mr.
M

PATRA,

Professor,

Commerce

department,

BASUBIR

FOUNDATION, SMU LEARNING CENTRE, for their support and

guidance.

Words are inadequate to express my sincere gratitude to Mr. KANCHAN

PATHAK, Mr. ARNAB DE, MS. KABERI KUNDU & MR. SUDIP
BHATTACHARYA for the most kind-hearted help rendered to me for the
successful completion of my project work.

I express my sincere gratitude to Ms. SOMA CHAKRABORTY, General

Manager (Operation) of Medical Superspecialty Hospital for her valuable
support, guidance and for entrusting me with this project in his reputed
organization.

I also convey my heartiest thanks to my Parents and Friends who helped me

in successful completion of my project.

Above I thank to almighty!

2|Page

DECLARATION

I, SWASTIKA KUNDU hereby declare that this project report titled THE
CURE

THE

TOTAL

QUALITY

MANAGEMENT

IN

SUPERSPECIALITY HOSPITAL - MEDICA , KOLKATA submitted

in partial fulfillment of the requirement for the degree of MASTER OF
BUSINESS ADMINISTRATION IN OPERATION, is a my original work
and it has not formed the basis for the award of any other degree.

Place : KOLKATA
Date

SWASTIKA KUNDU

3|Page

BONAFIDE CERTIFICATE

To Whom So Ever It May Concern

This is to certify that the Project Work titled
TOTAL

QUALITY

THE CURE THE

MANAGEMENT

SUPERSPECIALITYHOSPITAL -

IN

MEDICA , KOLKATA is a

bonafide work of SWASTIKA KUNDU (Reg. No: 1302003216) carried

out in partial fulfillment for the award of degree of MBA OPERATION of
Sikkim Manipal University under my guidance.

This project work, to the best of my knowledge, is original and not submitted
earlier for the award of any degree / diploma or associate ship of any other
University / Institution.

I wish all of her success in future.

Debasri Dey
Assistant Professor, IMS, KOLKATA

4|Page

CONTENTS
Chapter

Chapter Name

Page No.

Chapter-01

Introduction

10

Chapter-02

Project detail

11

Chapter-03

Company Profile

20

Chapter-04

Research Methodology & Design

27

Chapter-05

Data Interpretation and Analysis

39

Chapter-06

Findings

64

Chapter-07

Recommendation

75

Chapter-08

Conclusion

82

5|Page

EXECUTIVE SUMMARY
An extensive study has been performed by me (Swastika Kundu), a student of Sikkim
Manipal University of Masters of Business Administration, 4th semester, Campus.
It is a summarized idea of The Total Quality Management (TQM) in a Superspecialty
Hospital.
There are no systematic reviews of hospital quality strategies but there are some reviews
of interventions which could be used as part of a strategy.
The object of the study has been to understand the spaces & facility on which I can work
broadly which are State-Of-The-Art Medical Equipment, a team of highly qualified and
trained management Professionals, world class doctors, caring paramedical staff,
technicians and patient care personnel, Clean Hygienic OPD and In-patient facilities,
Intensive Care Unit (ICU) Medical, Surgical and Cardiac, Emergency Services, Regular
educational and health.
Ensuring the safety of patients and personnel and improving quality should be important
objectives for superspecialty hospital in developed and developing countries alike, in
response to research highlighting poor quality & increasing patient expectations.
Problem statement for this project are mentioned as follows
All time, employee involvement in quality improvement is not to the desired levels. There
is some resistance to change among them to suit the changing business environment. This
resistance needs to be reduced in order to ensure better employee indolent.
The hospital quality program is based on the evolution of departmental practices against
establish the standards. The focus is therefore on subsystem with the hospital quality
control programmed essential the sum of all departments program.
The standards, which have been set, are by medical officers, not the patients, and thus
they create a mismatch between the user needs and the services provided. Furthermore,
the set standards tend to remain static, so that improvement occurs within a limited range.
Decision-makers may always not aware that the same strategy applied in a different
location that may well yield different results, even if fully implemented in exactly the
same manner. In that case when reviewing types of strategies, hospital should question

6|Page

the claims of proponents of any one approach that will be applied to improve quality all
over.
To collect data regarding my project I have used some methods like- Primary &
Secondary data collection method. SWOT analysis is used after collection of data. To
collect some methods are also used which are Detailed Process, Management and
Monitoring and Continual Improvement, Frequent Auditing, Measuring and Controlling,
Quality indicator comparison.
Findings for the project are regarding Quality Measurement; Maintaining Focus on
Continuous Improvement. Related recommendations for that project are Quality Control,
Job Enrichment Characteristics, Cost of quality; Other approaches for improving quality
and patient safety, Control Plan, Total Quality Approach, Benchmarking & Auditing.
This paper presents the description on Healthcare organizations are required to focus on
Total quality improve:- Rendering acceptable, quality health services to patients at
affordable price within reasonable price, within in a reasonable time; Applying zero
errors to all patients services; maintaining a continuous error prevention program;
Training employees in medical care on such aspects as error prevention, reducing delay
time and providing prompt reasonable to patients needs; management system have always
improvement in such systems to realize the true nature of the quality of healthcare and to
be motivated towards improving this quality.

7|Page

A Tribute to Modern Saint : Mother Teresa

"The fruit of silence is prayer, the fruit of prayer is faith, the fruit of faith is love, the fruit
of love is service, the fruit of service is peace"

Mother Teresa

8|Page

CHAPTER 1

INTRODUCTION

9|Page

Now a day, Healthcare systems are of fundamental interests to all level of Hospitals in
our societies. Eventually, increasing importance and reliance are placed on total quality
management in healthcare systems. Due to this rising importance that is also reflected in
the increasing percentage of national and international resources for both private and
public sector to allocated in hospital management systems.
Hospitals and other healthcare organization across the globe have been progressively
implementing TQM to reduce costs, improve efficiency and provide high quality patient
care. Contrary to popular belief, the TQM movements were not the start of concerns
about quality in healthcare. The roots of

quality assurance initiatives in healthcare

extends at least as far back as the time of Florance Nightangless work during the
Crimean War(1854-1856), when the introduction of nutrition, sanitation and infection
control initiatives in war hospitals contributed to reduction in the death rate from 43% to
10%. TQM can be an important part of hospitals competitive strategy. Thus, TQM,
which places on improved customer satisfaction, offers the prospect of great market share
and profitability. TQM can be an important part of hospitals competitive strategy in
quality of healthcare system. Hospitals in competitive markets are more likely to attempt
to differentiate themselves from their competitors on the basic of greater service quality.
Thus, TQM which places a heavy emphasis on improvement in Customer satisfaction
index that offers the prospect of grater combines internal quality measures with value
analysis and conformance to specifications. Acceptable quality services not only include
direct medical services such as diagnoses, medicines, surgery and treatment but indirect
operations such as administration and purchasing whose costs are reflected in what the
buyer pays. It may also include Total Quality of performance that is directly related to
healthcare safety, security, attitude of nursing and word boy, role of doctors in terms of
time includes appointment, delay time, service time, timing with regards to medical
treatment and surgery.

10 | P a g e

CHAPETER 2

PROJECT DETAILS
Need for the study

People define quality in many ways. Some think of quality as superiority of excellence,
others vies it as a lack of patient care and service defects. According to Crosby, quality is
'conformance to requirements'. (Zero defects). Today most mangers agree that the main
reason to purse quality is to satisfy the customers. The American National Standards
Institute (ANSI) and American Society Quality (ASQ) define quality as The totality of
features and characterizes of a care or service that bears on its ability to satisfy given
needs. The view of quality as the satisfaction of customer needs is often called fitness for
use.
Objectives of the Study
To study the function and infrastructural facility of the quality management in the
hospital.
To get an overview the entire system prevailing in the department.
To find out how hospitals maintains the level of customer satisfaction.
To find out how hospitals respond appropriately for improving the service quality
& customer satisfaction.

11 | P a g e

 Deep insight about the Clients requirements and to search for their optimum
satisfaction is a matter of keeping in priority issue about providing more improved
quality services.
Staffing pattern and exploitation of human resource to the optimum level has been
taken into careful analysis.
To find how to reduce wasting of time.
To know the reasons for inappropriate delivery process of care.
To find out the better method for improving quality in prompt delivery of service.
To assess the reaction of the consumers of the firm to make suitable policy for
quality.
To estimate the probable time for a patient from entering to discharge in hospital.
Problem statements
Quality Management for a hospital provides a framework to help the organisation for
communicate, monitor and continuously improve all aspects of health care delivery. For
improving my hospitals quality, supports of some key areas are very important which are
personnel, client, top management, quality etc. Some basic area which need to improve
those are Doctor-patient relationship, reducing In-patient harassment- starting from
admission to discharge, Out-patient waiting time in que, Counselling regarding any
procedure of patient, non-clinical personnel - patient relationship & staff management. It
also presents evidence to support the proposition that an organized system to achieve high
quality care can lead to lower health care costs. In the present national environment a
highly structured approach to the pursuit of quality is essential.
Quality tools are used by multidisciplinary teams of workers to make changes, and the
approach is generally thought to require strong management leadership. It is based on a
view that quality problems are more often due to poor organization than to individual
faults.
Ensuring the safety of patients and personnel and improving quality should be important
objectives for superspecialty hospital in developed and developing countries alike, in
response to research highlighting poor quality & increasing patient expectations.

12 | P a g e

All time, employee involvement in quality improvement is not to the desired levels. There
is some resistance to change among them to suit the changing business environment. This
resistance needs to be reduced in order to ensure better employee indolent.
The hospital quality program is based on the evolution of departmental practices against
establish the standards. The focus is therefore on subsystem with the hospital quality
control programmed essential the sum of all departments program.
The standards, which have been set, are by medical officers, not the patients, and thus
they create a mismatch between the user needs and the services provided. Furthermore,
the set standards tend to remain static, so that improvement occurs within a limited range.
Decision-makers may always not aware that the same strategy applied in a different
location that may well yield different results, even if fully implemented in exactly the
same manner. In that case when reviewing types of strategies, hospital should question
the claims of proponents of any one approach that will be applied to improve quality all
over.
There are no systematic reviews of hospital quality strategies but there are some reviews
of interventions which could be used as part of a strategy. Distributing educational
materials to professionals has little effect, according to one review but other reviews
suggest that this approach is more effective if combined with audit and feedback &
computerized prompts.
Scope of the study
Health services include a wide variety of quality aspects, all of which are important. In
the case of medical services, the seller is doctors, hospitals, nursing homes, clinics, etc.
because they offer health services for sale as stipulated prices. The buyer is the client or
patient who buys these health services at the stipulated prices. It may also included
quality of performance that is directly connected and closely related to healthcare such as
food, housing, safety, security, attitude of employees and other factors that arise in
connection with hospitals and nursing homes.
There are four major activates which fall under the domain of quality. Those are follows:

Quality Assurance: This includes both retrospective review of adverse events &
prospective planning to prevent these events. The majority of adverse events are

13 | P a g e

brought to attention through electronic reporting, as well as security logs, patient

complaints & malpractice complaints. Root cause analysis process is used to
identify modifiable system-level causes of poor outcomes.

Internal Quality Improvement: The department is engaged in a number of

bottom-up quality improvement efforts with a focus on process changes. Two
large-scale examples include efforts to improve the rate of screening for problem
& efforts to improve adherence to guidelines.

Clinical Credentialing/Privileging: This process includes new efforts to establish

objective provider performance evaluation & focused provider performance
evaluation. Given the large percentage of clinicians who hold clinical
appointments supervise or teach rather than actively caring for patients.

Meeting external quality mandates: A final aspect of departments quality

efforts includes meeting the mandates for quality measurement imposed by a
growing number of payers & regulators. Requirements include the implementation
& reporting of aggregate outcomes measures to guide outpatient care.

Elements of TQM:
A. Customer Focus:
The customer is the judge of quality. From the TQ perspective, all strategic decisions a
healthcare institute makes are customer driven. Customer driven firms measure the
factors that drive customer satisfaction. The perception of value and satisfaction are
infused by many factors through the customers overall purchase, ownership and services.
Also reducing defects and error and eliminating causes of dissatisfaction contribute
significantly to companys views of quality. Also, customer opinion surveys and focuses
techniques can help to understand the customer requirements and values. Customer focus
extends beyond the customer and internal relationships; however society represents an
important customer of business. Business ethics, patients health and safety, environment
and sharing of quality standards in the healthcare systems and communities are necessary
activities.

14 | P a g e

B. Strategic planning and Leadership:

Strategic planning needs to anticipate many changes such as customers expectations,
new opportunities, advance diagnostic technologies development; evolving patients care
system and social expectations. Achieving quality and healthcare service leadership
requires a strong future orientation and a willingness to make, long-term relations ion to
key customers, employees, doctors, nurses, suppliers, the public and private community.
Through their personal roles in planning, reviewing healthcare quality performance, and
staffs for quality achieving, the seniors leaders serve as role model reinforcing the values
and encouraging leadership through the organization.
C. Continues improvement and learning:
Continues improvement is part of the management of all system and process. Achieving
the highest of performance requires a well-defined and well-executed approach to
continue improvement and learning. Learning refers to adaption to changes, leading to
new goals or approaches. Improvements and learning need to be embedded in the way an
organization operates. The process of continues improvement must contain regular cycles
of planning, execution and evolution.
D. Empowerment and Teamwork:
A healthcare institutes success depends increasingly on the knowledge, skills and
motivation of its work force. In healthcare management, individuals and departments
work for themselves. In TQ individuals cooperate in team structures such as quality
circles, steering committees and self-directed work teams. Department works together
towards system optimization through cross-function team-work.
E. Process management:
Deming and Juran observed that while majority of the quality problems are associated
with processes, few are caused by workers themselves. It is involves planning and
administrator the activities necessary to achieve a high level of performance in a process
and identifying opportunities for improving quality and customer satisfaction.
F. Tools for process management:
The tools and techniques along with management practices and the organizational
infrastructure should be processed properly.

15 | P a g e

The various tools for improving process management are:

Team-building and group-integration tools
Specific process/technical tools
Process flow chart
Check sheet and Histograms
Pareto analysis
Fishbone Charts
Process control chart
Quality function Deployment (QFD)
Poka-Yoka or Fail sating
G. Quality Assurance and Control:
Quality assurance is the planned or systematic actions necessary to provide adequate
confidence that a patient services or safety will satisfy given requirement for quality. The
activity of this department includes quality planning, control, improvement, internal audit
and reliability. Moreover it also includes quality advice and expertise, training of
personnel in quality, analysis of customer diagnosis, treatment records, medical claims
details, and patients liability cases. Management is responsible for defining,
documenting and supporting the quality policy, quality manual, performance, safety and
dependability. In quality manual system that defined as an assembly of components such
as the organization structure, responsibility, procedures and resources for implementing
quality management must be documented in the form of a quality manual.

16 | P a g e

CHAPTER 3

HOSPITAL PROFILE

Medica Superspeciality Hospital: Caring for life

Serving Patients from All Walks of Life. One of the largest hospitals in Eastern India, the
300-bedded Medica Superspecialty Hospital is a unit of Medica Synergie, a company
started by a group of healthcare professionals based in Kolkata, West Bengal, providing
integrated healthcare solutions through various verticals which include hospital
architectural planning and building, managing hospitals, public health, quality
accreditations and retail pharmacy. Located behind Metro Cash and Carry on the EM
Bypass, the hospital was formally inaugurated on April 14, 2010.
Philosophy of Medica:The focus is on establishing a modern healthcare network beyond the metro limits to the
districts where the majority of the population lives thereby increasing access to quality
healthcare for a larger section of the population.
The Company is focused on lowering the cost of care through a scientific process
involving resource rationalization, operating process improvement, appropriate use of
Information Technology, judicious HRD intervention and above all, nurturing a team of
doctors towards building an institution of excel lance through adopting international best

17 | P a g e

practices in evidence-based care and protocol-based approach to treatment. All these

steps, at the same time, contribute to improving the quality of care.
Better quality at affordable Cost remains our objective; thus further improving
access to healthcare to a wider cross-section of the society.
The three critical plans of our service model are:
Community Connect: - This company has operated on more than 550 children from
poor socio-economic background free of cost to patient; the cost of surgery being partly
subsidized by us, and partly funded by Operation Smile. This collaboration was started in
2010 and the response is quite encouraging as more and more families are coming
forward and reaping the benefits of the surgeries with a hope to heal their childrens
smiles.
Partnering Corporate Bodies:- We provide innovative and comprehensive solutions in
the domain of health-care to various mid-large companies that help them to reduce their
healthcare expenditure while ensuring a more holistic care to our employees.
Patient-Centric Approach:- High ethical standards, transparency in every transaction, a
humane workforce; all go towards creating that envelope of care around every patient
which begins healing, beyond treating.
This hospital has become the destination of choice for all discerning patients from within
the country and abroad because it:

Offers world-class care at affordable cost

Employs personnel with rich experience and impeccable credentials
Deploys state-of the-art equipment and technologies
Believes in multi-disciplinary teamwork
Produces results on par with the best in the West
Sets benchmarks in quality, safety and innovation
Exceeds patient expectations by going the extra mile in service.

18 | P a g e

 Key facilities at Medica Hospital:

24 hrs Trauma and Critical care (ICU) at our service, delivering the best in
quality healthcare

Neonatal & Pediatric Critical Care Units; Neonatal & Pediatric Surgery

High-risk Pregnancy Management

Joint Replacement & Arthroscopic Surgery

Advanced Laparoscopic Surgery, including Colo-rectal Surgery

Specialty Medicine Gastroenterology, Chest Medicine

Nephrology & Dialysis.

Specialty Surgery Urology, Plastic & Micro-vascular.

Ophthalmology- Phacoemulsification surgery/IOL microsurgery, Glaucoma

surgery and other eye care related services.

Patient Care at MSH

High ethical standards, transparency in transactions, humane workforce all creates an
ambience of personalized care which begins healing beyond treating.
Operation Theatres:The hospital has 10 ultra-modern operating theatres. Latest Anesthesia machines,
Monitors, Diathermy etc. combine to ensure highest standards of patient-safety besides
spacious Recovery area where the patient is observed to ensure safe return to normal
hospital bed.
ICU/ NICU/ PICU:State-of-the-art ventilators, Monitors, Portable USG/Echo., Methods for non-invasive
ventilation using Bi-PAP and C-PAP, Facility for Temporary Pacemaker, Arterial Blood
Gas estimation, dedicated team of nurses all you need for critical care.
Support Services:Dietician, Physiotherapist, Clinical Psychologist, Speech Therapist the solution is endto-end at all levels.

19 | P a g e

Accident and Emergency:The hospital has a Full-time Consultant in Emergency trained in UK setting new
standards in immediate care in Trauma, Minor & Major emergency.
Mother and Child:A part of hospital is dedicated to the care of a new mother and her newborn with their
special needs for comfort, privacy and safety; we believe babies are best looked after by
their mothers, hence we encourage new mothers to breast-feed their babies in the privacy
of separate designated rooms.
Accommodation:In a bid to provide best quality of care and treatment to you we have not forgotten your
near & dear ones, your relatives, as we understand their anxiety and desire to stay close to
you. THEY CAN in our well-furnished A C guest house.
Pharmacy and Ambulance:The hospital has 24-hours pharmacy and ambulance services. The pharmacy is open to
all, at all hours and there are three ambulances ready for patients service.
Dietary Services:The in house kitchen prepares wholesome food for you under supervision, in a hightechnology and hygienic environment taking care of your entire nutritional requirement.
Laundry:The in-hospital state-of-the-art laundry ensures an infection-free environment.
This hospital is also known for cost-effective medical treatment to every economic
stratum of the society and has succeeded in becoming the most trusted hospital in India.
Specialty Available at MSH:Medica Institute of cardiac science
Medica Institute of Neurological Disease (MIND)
Medica Institute of Kidney Disease
Medica Institute of Orthopedic Sciences
Medica Institute of Gastroenterology & G I Surgery

20 | P a g e

Medica Institute of Critical Care (MICC)

Medica ENT Institute
Medica Institute of Breast Disease
Pediatric Cardiology
Nutrition & Dietetics Neonatology
Respiratory medicine general oncology
Dermatology
Diabetology
General surgery
HLA & Molecular lab
Gynaecology & Obstetrics
Psychiatry Anesthesiology
Radiology
General Medicine
Rehabilitation services
Plastic surgery
Dentists
Emergency services
OPD Services:OPD Registration time: 8:00A.M.-6:00P.M.
OPD Clinic:

8:00 A.M.-7:00P.M

Different facilities of Hospital: -

Round the clock emergency

Round the clock Admission
Round the clock CT scan facility
Cardiac Ambulance
Diabetic Foot Clinic with foot scan facility

21 | P a g e

 Dialysis Unit
Acceptances of the credit card
Master health check-up
Cardiac profile scheme

22 | P a g e

CHAPTER 4

RESEARCH METHODOLOGY &

RESEARCH DESIGN
RESEARCH METHODOLOGY

Population of the area

Data collection plan:

Tools for data

collection

Sample Size
Primary Data
collection

Secondary Data
collection

Source of Data:

Continuous quality improvement protocol, quality indicator

sheet, follow-up sheet & patient feedback form from all
area

Types of Data:

Primary & Secondary data

Sampling Methodology:

Total population was considered

The research process is done through the below mentioned process:

Data collection method

Primary Data: Primary data collection method:

In primary data collection, I collect the data using methods such as interviews and
questionnaires. The key point here is that the data collect by me is unique and until I
publish it, no one else has access to it.
The primary data, which is generated by the above methods, may be qualitative in
nature (usually in the form of words) or quantities (usually in the form of numbers or
where you can make counts of words used).

Questionnaires:
Questionnaires are a popular means of collecting data, but are difficult to design
and often require many rewrites before an acceptable questionnaire is produced.

23 | P a g e

 Advantages of Primary Data:

Can be used as a method in its own right or as a basis for interviewing or a
telephone survey.
Can be posted, e-mailed or faxed.
Can cover a large number of people.
Wide geographic coverage.
Relatively cheap.
No prior arrangements are needed.
Avoids embarrassments on the part of the respondent.
Respondent can consider responses.
Possible anonymity of respondent.
No interviewer bias.

Disadvantages of Primary data: Design problems.

Questions have to be relatively simple.
Historically low response rate (although inducements may help).
Time delay whilst waiting for responses to be returned.
Require a return deadline.
Several reminders may be required.
Assumes no literacy problems.
No control over who completes it.
Not possible to give assistance if required.
Problems with incomplete questionnaires.
Replies not spontaneous and independent of each other.
Respondent can read all questions beforehand and then decide whether to
complete or not. For example, perhaps because it is too long, too complex,
uninteresting, or too personal.

24 | P a g e

 Secondary Data:In research, Secondary data is collected & possibly processed by people other than the
researcher in question. Common sources of secondary data for social science include
censuses, large surveys & organizational records. In Sociology, primary data is data you
have collected yourself & secondary data is data you have gathered from primary sources
to create new research. In terms of historical research, these two terms have different
meanings. A primary source is a book or set of archival records. A secondary source is a
summary of a book or set of records.

Tools for data collection: - There are many methods of collecting primary data &
the main methods include:
Questionnaires.
Interviews.
Focus group interviews.
Observation.
Case-studies.
Critical incidents.
Besides, a firm can also collects secondary data from other sources like:
Censes.
Survey.
News Paper.
Magazine.
Television.

SWOT ANALYSIS: SWOT analysis is done after collecting the data and information during the market study.
Here S means strengths, W means weaknesses, O means opportunities and T
means threats.

25 | P a g e

The strength and weaknesses are mainly related or dependant on the internal environment
factors. Opportunities and threats are based on the external environment factors i.e. the
hospital industry as a whole.

S for Strengths: Location

Technology
Environment
Behavior of staff, doctors etc.
Discount benefits provided.
Good and eminent full time consultants.
Revenue earned is in accordance to the budget formulated.
Good team work.
Good coordination.
Timely report dispatch.
Renowned doctors are empanelled.
Patients have wide options.

'W for Weakness: Lack of awareness.

Client not happy with the waiting time for doctors.
Radiology department do not have enough Radiologists for USG essential
for master health check.
Ambience not in par with the package charges designed.
Less number of referrals from in-house doctors.

O for Opportunity: The most renowned hospital like Aware Global hospitals can initiate the tie-ups
using its reputation in the market.
Proper policy should be formulated for the referral fees for doctors, so that they
can refer MHC Patients.

26 | P a g e

 When seasonal and festive discounts of the packages are given, proper
marketing of these discount packages should be done through advertisements.

T for Threats: Popular practice in major hospitals and even in nursing homes.
Price competition.
Project decreasing as there are less Patients at preventive health check department
than any department of the hospital.
High rates of the packages.
Less attention is given for promotional marketing of the preventive health checkup.
Corporate gets bugged for the high waiting time.
Once or twice, a week there is no cash patients at all.
Other estimated methodologies are used, mentioned as follows

100% Commitment

Client Driven

Detailed Process

Management and Monitoring and Continual Improvement

Frequent Auditing

Measuring and Controlling

Quality indicator comparison

Data collection Instruments

The following initiated TQM in MSH
The healthcare services, which were good old time, barely meet the requirement
of today and will adequate tomorrow. Customers need to continue increase
demands in services.
In the age of technological revolution in medical, customers expected speedy
response to their queries and services.

27 | P a g e

 Employee involvement in quality improvement was not to the desired levels.

There was resistance to change among them to suit the changing business
environment. This resistance needed to be reduced in order to ensure better
employee indolent.
The management was satisfied with the prevailing levels of quality. This
satisfaction arose out of comparing the present performance with the previous
years performance, instead of the performance expected customers.
The present hospital quality program is based on the evolution of departmental
practices against establish the standards. The focus is therefore on subsystem with
the hospital quality control programmed essential the sum of all departments
program.
The standards, which have been set, are by medical officers, not the patients, and
thus they create a mismatch between the user needs and the services provided.
Furthermore, the set standards tend to remain static, so that improvement occurs
within a limited range.
After several months of planning a quality transformation model was developed to help
participants visualize the score of the quality management effort.
Tools & Techniques used
Qualitative: Quantitative research is used to quantify the problem by way of generating
numerical data or data that can be transformed into useable statistics. But quality does not
talk about quantity. Qualitative research is primarily exploratory research. It is used to
gain an understanding of underlying reasons, opinions & motivations.
Simulation: Simulation is a widely used in the design of systems of almost all kinds &
yet seems to be used rarely in the design & analysis of quality management systems.
Explores the reported applications of simulation in this & other fields relating to quality
& concludes that the benefits of simulation could make a significant contribution to the
continuous improvement of the quality management systems.

28 | P a g e

Statistical quality control (SQC): It is a methodology that separates random variation

from specific variation. It offers a means by which specific variation may be identified
and then removed, by eliminating performance variation at key steps in the process. It
also prevents well-meaning but uninformed changes that waste effort and, potentially,
damage the process.
RESEARCH DESIGN
Present Organogam of MSH
Quality is assessed at all departments & maintained the workflow as per the below
mentioned diagram.

29 | P a g e

 Various Approaches which we follows to continue research for quality:

Vision - Committed to bringing the best in healthcare to Kolkata
Mission- We deliver excellent clinical outcome with superior patient care in a
transparent manner within a safe environment
Pledge- I will honour my commitment to quality in my hospital.
In keeping with this commitment, MSH will pursue global standards of superior
medical care through qualified medical & support staff, cutting edge technology, an
environment for continuous learning & development & patient centric interaction
All team members at MSH, whether in management or in medical services, will
support of its Quality Management philosophy of its Quality Management systems for
planned development, through self evaluation & corrective action to meet & exceed
the expectations of our patients.
During research some key points support us to get best quality which are
mentioned as follows:
Best of Manpower
Empowerment of women being one of Medicas main thrust areas, 80 per cent of the
hospitals employees are women. Medicas present staff strength includes 108 medical
personnel, 374 support staff and 370 nursing staff.

30 | P a g e

Branding
Medica is one of the largest hospitals in Eastern India providing the best treatment in a
patient friendly ambience at the best possible rates.
Infection Control
Medica follows a strict infection control policy with various checks and balances and
staff training programmes. Regular awareness programmes and training sessions are held
for both the hospital staff and also for patient visitors to avoid spread of infection. Posters
on hand hygiene have been put up in various strategic areas for the benefit of visitors to
the hospital.
Future Plans
Our plan is to increase its present bed strength in Eastern India to 2000 beds in the next
two years with an investment of 300 crore. The group is planning a chain of hospitals
(new and acquired) in Bihar, Orissa, Jharkhand and the North-east.
In spite of a recent spurt in healthcare units, Eastern India is still lacking in this area
compared to the rest of the country, with there being just not enough hospitals to cater to
the needs of the patients. People from West Bengal travel to Mumbai, Bangalore,
Hyderabad and Chennai looking for better treatment options at an affordable cost. Feeling
an intense need to try and stem this tide and provide the people of this region with good
yet affordable options closer home, we are planning to launch a chain of hospitals, some
new and some by providing infrastructural support to existing units, all over Eastern
India, said Dr. Alok Roy, Chairman, Medica Superspeciality Hospital, Kolkata.
Patient Guide
Every visitor to the hospital is greeted by a smiling young trainee, stationed at the May I
Help You desk in the lobby, whose sole job is to make the patient comfortable.

31 | P a g e

Advanced technology, treatment and care

32 | P a g e

CHAPTER 5

DATA ANALYSIS & INTERPRETATION

Quality Policy
Since MSH is committed to provide the best in healthcare at an affordable cost, in a safe
and comfortable care environment in a transparent and ethical manner.
In keeping with this commitment, MSH will pursue global standards of superior medical
care through qualified medical and support staff, cutting edge technology, an environment
for continuous learning and development, and patient centric interactions. All team
members at MSH, whether in management or in medical services, will support the
continuous improvement philosophy of its Quality Management Systems for planned
development, through self evaluation and corrective action to meet and exceed the
expectations of our patients.

33 | P a g e

 Procedure of maintaining quality of service in MSH:-

Plan For
Quality
Assurance

Decide On &
Implement Solutions

Set Standards &

Guidelines

34 | P a g e

Monitor
Quality of Services

Decide On and
Implement Solutions

35 | P a g e

Identify & Priorities

What Can Be
Improved

Suggest
Solutions

Define The
Problem

36 | P a g e

Analyze The
Study of Problem

Decide Who Will Work on

the Problem

The four major divisions of operational model for quality in our hospital

37 | P a g e

Quality of management- In our quality management program, our ultimate goal is to

have universal adherence to the quality & safety practices guidelines that we adopt & to
reduce adverse events over time, to the lowest achievable & to zero where possible.
Quality of management is the first part which we need to improve for improving the
quality. To improve the quality of management we follow a systematic flow that helps us
to carry on the improving quality procedure. Key points under quality of management
are Quality-based mission statement
Commitment of top management
Dedication to continuous improvement/innovation
Remove obstacles to improvement
Understand basic principles
Educate

38 | P a g e

 In intelligiblemission
terms statement
Quality-based
With a measurement system
Customer-based

Commitment of top management

Constancy of purpose
Systems determine quality and
management controls the system

Dedication to continuous
improvement/innovation

Quality is based on expectations

Expectations are a moving target
document continuous improvement

Focus on the "customer"

Quality of
Organization/
management

Two-way communications and

education are required if expectations
are to be reasonable and have some
change of being met
"customers" include physicians,
financiers, suppliers patients and
their families
supervisors should never become the
primary "customer"

Remove obstacles to improvement

Build systems that encourage

innovation
Eliminate fear/system defects
which promote fear
Avoid inspection / tampering

Understand basic principles

role of theory in controlling systems

need for leadership to achieve quality

Educate- all members of system

39 | P a g e

Quality of evaluation- Conducting detailed evaluation of improvement activity is key to

our understanding of which methods & innovations work to improve quality. We want to
know which small scale changes can be replicated across our service to bring about
improvement on a large scale.
It is therefore necessary to continually measure progress toward quality goals and to study
the underlying processes of the business in order to encourage innovation and continual
improvement.
In order to effectively evaluate quality, our management must understand the principles
of random variation as they relate to quality. These include an understanding of the
differences between enumerative and analytic techniques, the ability to measure random
variation, the ability to identify.

Understand basic principles

Quality of

Theory of variation
Random versus nonrandom causes
Enumerative versus analytic
techniques
Research versus inspection
The aim of research is substantive
knowledge which leads to positive
changes in the system

Evaluation
Educate
All members of the organization about
the basic principles, formal
measurement and analysis, and
quality management techniques

Reduce Variation
Assist other organizational entities in
the collection, analysis, and
interpretation of data to improve the
process

40 | P a g e

Types of research
Opinion research (to measure expectations and satisfaction)
Health care delivery research (to control utilization and increase value of care)
Clinical research (to improve underlying health care products)
Quality of service (Delivery Quality) - It is therefore critical that the organization
understand the wants, needs, perceptions, and expectations of its customer groups. For the
purposes of this presentation these factors are grouped under the heading of Quality of
Service. A first critical step in understanding customer (patient) satisfaction and
expectations is to clearly define those customers an organization serves.
Quality of service allows an organization to successfully satisfy its customers. Our
hospital serves not only patients but patient families, physicians, health care financiers,
and suppliers. We attempts to serve all groups associated with the hospital. Since we have
value in addressing the needs of individual customers, it is seriously flawed as a means Of
understanding the reaction of an entire customer population to the organization's products
and services. There are some patients, though extremely dissatisfied, never complainthey simply never return to the organization and advise all of their associates to stay away
too.
The chief tools for understanding the concerns, needs, and expectations of a broad
customer population are questionnaires and customer focus groups.

41 | P a g e

Identify customer groups

Patients and families
Payors (government and industry)
Physicians (primary and
secondary)
Hospital departments
Suppliers

Define interactions among customers

Quality of
Service

e.g., secondary physicians serve

primary physicians
e.g., hospital departments serve
physicians
e.g., hospital departments serve
other departments
e.g., physicians and departments
serve patients

Devise measures and means of data collection

e.g., satisfaction with hospital
care
e.g., long-term output-morbidity
and quality of life

Analyze and report results

Focus on trends ("documents
continuous improvement")

Generate and test ideas for modification of

systems
Educate customers
To understand the product and
have reasonable expectations

42 | P a g e

Value of care (Content Quality) - While our patients or other external customers
determine expectations for the quality of delivery of medical care services, the medical
content of care that is provided is still almost exclusively the province of the medical
profession itself. This section therefore concerns itself with the quality of the content of
medical care, as determined by health care professionals.
We represent the value as a combination of the quality of the medical care content that is
delivered and the price at which it is achieved.
We have the necessary tools and the necessary knowledge to intervene in disease
processes with a positive result.
Once the infrastructure is in place, a decision must be made to intervene (the diagnostic
process) and a particular intervention (course of treatment) must be undertaken. The final
result of this entire process is a health care outcome.

43 | P a g e

Infrastructure for high quality clinical

care facilities professional foundation
Physical

Maintenance
Assessment
of new technology

manpower planning
& recruitment
CME
Research affiliations

Reduce inappropriate variation in indications for

treatment

Value of
Care

adequacy of diagnosis
appropriateness of procedures
systems for informed consent

Reduce inappropriate variation in patterns of

care
Evaluate cost versus output
Diagnosis, comorbidity, and
acuity adjusted
Compare outcomes among
physicians and hospitals
Measure hospital afficiency vs.
physician utilization

Avoid / Mitigate errors

Traditional risk management /
insurance & tort reform
Focus on process mistakes, not
just bad outcomes

Screen using risk-adjusted outcomes

Improve the underlying medical science
(clinical research)
Discover improved means by
which to treat disease
Improve the possible outcomes
of treatment

44 | P a g e

 OUR SYSTEM FOR CONTINUOUS QUALITY IMPROVEMENT AND

COST CONTROL
Achieving high quality and appropriate cost reductions involves three major
steps: (1) prepare to improve, (2) implement, and (3) innovate. Once a CQI system is in
place, steps 2 and 3 cycle continuously. These steps can also be stated in CQI's two
primary principles:
To continuously improve quality and appropriately control costs, eliminate inappropriate
variation and document continuous improvement. Their effective application depends
upon a clear understanding of the nature of quality ("quality is meeting customer
expectations"), the role of process in achieving quality, and the relationship between
quality and cost.
Find a process

Assemble a team that knows the process

Identify customers, identify process outputs, and measure customer expectations

regarding the outputs

Document the process

Generate output and process specifications

Eliminate inappropriate variation

Document continuous improvement

Find a process: The first step is to choose a process that needs quality improvement and
cost control. Individual diagnoses and procedures (health care products) each represent a
process. Taken together they form the heart of health care delivery. Other processes cut

45 | P a g e

across diagnostic lines, like- admission to the hospital, billing, or analyzing a single blood
test are all definable processes that cross diagnostic lines.
Assemble a team that knows the process: Here a process is nearly always use who
perform it on a daily basisfrontline workers. We must also have an understanding of
continuous quality improvement principles, statistical quality control, the use of data
management systems, and access to management so that organizational roadblocks to
improvement can be overcome.
Identify customers, identify process outputs, and measure customer expectations
regarding the outputs: Quality is meeting or exceeding the expectations held by a
process's customers (with the proviso that expectations can be changed, over time,
through customer education). But different processes have different outputs and often
have different customers. Our first task is therefore to list the outputs of the process,
identify its customers and measure their expectations of its outputs. We soon degenerate
into systems for making the company look good in its own eyes, instead of meeting
customers' expectations and thus protecting the company's
Document the process: This process consists of a series of steps that convert inputs into
outputs. The main process is broken down into sub-processes, each with sub-inputs and
sub-outputs. Each of the resulting sub-processes may similarly be broken down into subsub-processes, again with sub-sub-inputs and sub-sub-outputs. The hierarchical chain is
followed to that level of detail necessary to understand the process.
Generate output and process specifications: A specification is an explicit, measurable,
statement regarding an important attribute of an output (a customer expectation) or the
(sub) process that produces it (key process factors). Note that specifications are generated
in two areas: external, customer expectations and internal, process expectations. They
reflect both the goals that a process was created to achieve, and the manner in which
those goals are planned to be accomplished. They must be stated so that they are
explicitly measurable. Finally, they should be updated as customer expectations change
and as the process is improved.

46 | P a g e

Quality cannot be achieved without a sufficient set of measurable specifications that

reflect customer expectations and key process factors. Specifications therefore provide
the basis for managing quality. Quality is conformance to specifications.
Eliminate inappropriate variation (Implement): Specifications define measurement
points. Once specifications are in place, those data points can be recorded for every
input/output that transits the process. The goal is to detect quality events (outcomes) in
sub-processes and final outputs,
Process from pre admission upto discharge with satisfaction of a patient:
Preadmission
1. Demographics
2. Disease history
3. Admit lab
4. Admitting process
5. Patient education
Hospital course
6. Day of admission surgery
7. Surgical process
8. Foley catheter management
9. Short-term complications
10. Laboratory
11. Pathology
Medical outcomes
12. Outplacement: Discharge destination
13. Long-term complications:
14. Medical outcome
Patient satisfaction
15. Patient satisfaction with his or her hospital stay

By this manner, the procedure is performed and we get final results. Quality is improved
by measuring and modifying the Process, not sifting the Output to identify failures that

47 | P a g e

need to be reworked or thrown away. The system for causing quality is prevention, not
appraisal. CQI theory is used to describe the act of evaluating exceptions as "sorting
through failures," or inspection.
CQI emphasizes the same concept by distinguishing two types of analysis: enumeration is
the act of classifying then counting----statistically analyzing----outcome data.
We use two types of variation as per CQI process:
Random variation (random causes, common variation or causes) results from variation in
the inputs that a process receives or inherent factors in the process itself.
Specific variation (specific causes, special variation or causes, attributable variation
or causes) represents an attributable contribution to variation arising from one or
more specific components within the process.
Our aim is to eliminate specific variation so that only random noise remains.
Document continuous improvement: Once non-random variation has been
removed from a process that process becomes is search system within which the
scientific method is applied to test.
We, fundamental knowledge of the process, can generate ideas about how the
process is changed to improve quality ("lead the customer") or increase productivity.
We can select those ideas that seem most promising and then apply on a test basis
within process. Because other causal factors of variation have been eliminated, the
impact of the innovation can be directly observed. The proposed change can then be
discarded, implemented, or modified and tried again, based upon the results of the
test.

48 | P a g e

Relationship of cost to quality is shows as cycle process which delivers the best outcomes
at the lowest appropriate cost. It can also document that accomplishment. A competitive
medical environment will reward our quality member and physicians who continually
improve medical value- we will attract more patients. The rewards to be gained through a
clinical laboratory are (1) better medical quality, (2) lower costs and (3) survival
The impact of effective standards versus continuous quality improvement on
the location and spread of a quality indicator

49 | P a g e

The principle of eliminate inappropriate variation draws the curve higher and tighter
about its central point, and the principle of document continuous improvement shifts the
entire curve to the right.
The dot on the left side of each curve represents a low-quality producera true "bad
apple" that traditional standards are designed to identify and eliminate. Using standards, a
low quality producer can hide just within the line. But as CQI tightens the curve and
shifts it to the right, low-quality producers become more and more exposed.
They must improve their process or be easily identified as consistent (and severe) quality
outliers. CQI can eliminate true "bad apples" as efficiently as standards.

Mandatory Indicators which are maintained in different areas

SL.NO.

INDICATORS

AREA

Percentage of cases (in-patients) where in nursing Nursing

care plan is documented.

Percentage of patients receiving high risk Nursing

medications receiving high risk medications
developing adverse drug event
Percentage of unplanned return to OT
OT

Percentage of cases where the organizations OT

procedure to prevent adverse events like wrong site,
wrong patient & wrong surgery have been adhered
to.
Mortality rate
Medical Records

Return to ICU within 48 hrs

Return to the ED within 72 hrs with similar ER

presenting complaints
Re intubation rate
ICU

ICU

10

Percentage of serious adverse events (which have Clinical research

occurred in the organization) reported to the ethics
committee within the defined time frame.
Critical equipment downtime.
Biomedical

11

Incidence of blood body fluid exposures.

Infection control

50 | P a g e

SL.NO.

INDICATORS

AREA

Percentage of medical records not having Medical Records

codifications as per ICD
Percentage of cases who received
Wards
13
appropriate prophylactic antibiotics within
the specified time frame.
Cause-and-effect Analysis
12

This analysis is also called as Dispersion Analysis. It is the quality characteristic. It helps
to organize and relate the factors of the dispersion or effect. This Cause-and-effect
Analysis helps us to
Identify potential causes for quality problems.
Identify common problem solving tool.
Address specific issues related to quality.
Develop the analysis of the sources
One example of Cause effect analysis for poor quality service, occurred in
our hospital

51 | P a g e

Graphical Representation of educational demand & quality progress

Graphical representation of attention of our hospital for improving quality in

different area

Process Decision Program Chart

The Process Decision Program Chart (PDPC) is used to classify possible problems and
counter ways in a plan. It is used when we make plans & it helps to identify potential
risks. When risks are identified it helps to identify and select from a set of possible
counter measures.

52 | P a g e

Plan element

Possible
countermeasure

Possible
problem

Plan element

Possible
countermeasure

Plan element
PLAN

PDPC

Flow of Process Decision Program Chart

Risk Management
Two of the most common essentials of risk are cost & time, like there is a risk in a busy
timetable of key equipment being unavailable & subsequent time loss & extra expense
being acquired for providing services. There are three possible directions that are taken
for handling identified risk: Risk avoidance, risk reduction & contingency planning.
Select alternative actions
Risk avoidance
Abandon planned actions

Risk
Identified

Risk Reduction

Change actions to reduce

risk

Add actions to reduce risk

Contingency
Plan to cope with risk
planning
Flow of managing risk

53 | P a g e

 Patient population
The aim of this patient population study is to describe consequences of three inclusion
criteria in the buildup of different study populations, studied in terms of size, number of
doctor-patient contacts and demographic characteristics. Our hospital need to define our
role in the community as we navigate the ever-changing healthcare environment. To do
so, hospitals first have to understand our patient populations; like- inpatient services
attract local patients with chronic conditions, while cardiology, orthopedics and spine and
transplant services bring patients from across the country and world.
Our hospitals can do our part by providing services that help with the early diagnosis,
treatment and management of diseases that are affecting our community.
In addition to knowing the populations need serve and what health issues we face, when
defining their role in their community, hospitals must figure out different kind of
relationship to have with community members.
The strategic planning process is part of our team-building process of listening to our
doctors, our managers and directors, evaluating our patient population and looking at the
outside world and saying 'where do we fit in this world?

54 | P a g e

Patient
population

Patient case mix

Diagnosis
Severity
Comorbidities

Hospital Costs
Physical plant
Materials
Labor
Overhead
Hospital Practices
Hospital Efficiency
Hospital produces intermediate units
of care
Physician
Practices
Physician Resource Utilization
Physician combines intermediate units
of care into health care products

Reimbursement
Fee for service
Per Diem
Per Case
Managed care
Per capita
Net Income

Random clinical events

Efficiency of procedure
Technical quality
Physician skills
Hospital services
Medical Outcomes
Quality of outcome (Inpatient)
Patient compliance
Social support system
Health Outcomes
Functional status

55 | P a g e

 Six Sigma
The word Sigma is a statistical term that measures how far a given process
deviates from perfection. The central idea behind Six Sigma is that if we can measure
how many "defects" we have in a process, we can systematically figure out how to
eliminate them and get as close to "zero defects" as possible.
Six Sigma has some special features which we also follow. These are:

Six Sigma's aim is to eliminate waste and inefficiency, thereby increasing

customer satisfaction by delivering what the customer is expecting.

It is a highly disciplined process that helps us focus on developing and delivering

near-perfect products and services.

As per Six Sigma, we follow a structured methodology and defined roles for the
participants.

Since, Six Sigma is a data driven methodology, it requires accurate data collection
for the processes being analyzed.

Six Sigma helps about putting results on Financial Statements.

Since, Six Sigma is a business-driven, multi-dimensional structured approach to:
Improving Processes
Lowering Defects
Reducing process variability
Reducing costs
Increasing customer satisfaction
Increased profits.

Key Concepts of Six Sigma:Six Sigma revolves around a few key concepts.
These are:
Critical to Quality: Attributes most important to the customer.
Defect: Failing to deliver what the customer wants.

56 | P a g e

 Process Capability: What your process can deliver.

Variation: What the customer sees and feels.
Stable Operations: Ensuring consistent, predictable processes to improve
what the customer sees and feels.
Design for Six Sigma: Designing to meet customer needs and process
capability.

Myths about Six Sigma:There are several myths and misunderstandings about Six Sigma. Few are given
below:
Six Sigma is only concerned with reducing defects.
Six Sigma is a process for production or engineering.
Six Sigma cannot be applied to engineering activities.
Six Sigma uses difficult-to-understand statistics.
Six Sigma is just training.

Benefits of Six Sigma:There are following six major benefits of Six Sigma that attract companies. These
are:
Generates sustained success.
Sets a performance goal for everyone.
Enhances value to customers.
Accelerates the rate of improvement.
Promotes learning and cross-pollination.
Executes strategic change.

57 | P a g e

CHAPTER 6

FINDINGS
Quality Measurement
The management of key work processes should include provision for measurement.
Productivity is defined as the amount of output related to input resources. But we had mistakenly
calculated only one measure of output, i.e., the total (acceptable and non-acceptable). Now, the
pertinent output measure is that which is usable (i.e., acceptable output) by customers- Patient,
vendors, staff etc.
Subject
Quality of output

Quality of input

Unit of measure
Percentage of output meeting the specification
at inspection
Percentage of output meeting specification at
intermediate and final inspection
Number of defects found in product audit.
Percentage of critical operation with certified
workers.
Amount of downtime of manufacturing output.

Maintaining Focus on Continuous Improvement

Traditionally, the operations function has always been involved in troubleshooting sporadic
problems. As chronic problems were recognized, these were addressed using various approaches
such as quality improvement teams. Often the remedies for improvement involve quality planning
or re-planning. These three types of action are summarized in the table below:
Type of action to take

Troubleshooting

Quality improvement

Time to take action

Performance
indicator
outside control limits
Performance indicator in
clear trend toward control
limits
Control limits are so wide
that it is possible for the
process to be in control and

Steps for taking action

Identify problems
Diagnose problem
Take remedial action

Identify project
Establish project
Diagnose cause

58 | P a g e

Type of action to take

Time to take action

still miss the targets
Performance
indicator
frequently misses its target
Many
performance
indicators for this process
miss frequently
Customers have significant
needs that the product does
not meet

Quality Planning

Steps for taking action

Take remedial action
Establish project

Identify customers
Discover customer needs
Develop product
Develop process
Design controls

Maintaining the focus on improvement clearly requires a positive quality culture. So, we must
first determine the present quality culture and then take the steps to change the culture to one that
will foster continuous improvement. We can urge upper management to set up cross functional
terms to address operations problems that may be caused by other functional departments such as
engineering, purchasing and information technology.
Quality Control:
Quality Control (QC) is used to ensure that a performed service adheres to a defined set of quality
criteria & meets the requirements of our client.
Since, control process is a feedback loop; we maintain a universal sequence of steps as follows:
1. Choose the control subject, i.e., choose what we intend to regulate.
2. Establish measurement.
3. Establish standards of performance.
4. Measure actual performance.
5. Compare actual measured performance to standards.
6. Take action on the difference

Process

Sensor

Goal
Comparison

Actuator

Feedback loop

59 | P a g e

In every department, where a natural work team puts the control process into practice, three
purposes are served:
Preserve the gains from improvement projects.
Promote investigation of process variation based on data, to identify improvement
opportunities.
Allow the employees to simplify responsibilities and work to achieve a state of selfcontrol.
Job Enrichment Characteristics and Management Actions
Characteristics
Skill variety

Task identity

Task significance

Autonomy

Feedback

Definition
Extent to which the job has a
sufficient variety of activities to
require a diversity of employee
skills and talents.
Degree to which work requires
doing a job from starting till
end and results in a complete
visible unit of output
Degree to which the job affects
internal and external customers.

Amount of employee self

control in planning and doing
the work.
Degree to which direct
knowledge of results is
provided to employee.

Action
Combine tasks in order to
produce
larger
work
module.
Organize
work
into
meaningful
groups,
example, by customer, by
service.
Gives means of direct
communication and personal
contact
with
customer.
Gives employee greater
self-control for decision
making.
Create feedback system to
provide employees with
information directly from
the job.

"Cost of quality" (COQ)COQ is not the price of creating a quality product or service, but it is the cost of not creating a
quality product or service. The Cost of Quality measurement record changes over time for one
particular process and is also used as a benchmark for comparison of two or more different
processes. Generally, COQ is measured in currency including all losses and wastes to be
converted to their liquidated cost equivalent. An important example of quality cost that we found
out is lost for providing service due to poor quality. Many time work is redone, the cost of quality
increases. The cost includes:
The alteration of item

60 | P a g e

 The retesting of an assembly

The reconstruction of a tool
The rectification of a bank statement
Cost of poor quality & Action taken
Cost of poor quality

Action taken

Cost of non conformities

Providing education & motivating the employees

by training to reduce non conformities &
increase conformation.
Cost of inefficient process
Todays, modern technology requires more
improved & innovative process, so improvised
& highly adaptable techniques are processed to
reduce cost for repeated process changes.
Cost of lost opportunities for providing Since providing quality service in all society an
services
important key for our hospital, our hospital
provides a strong eligible marketing team to grip
up the opportunities for providing quality
services.
This study found that:
Many services had not introduced a full TQM strategy, but were encouraging small-scale
There were some changes in personnels understanding of quality methods and attitudes in
nearly all sites;
Little training was done in basic quality awareness, quality methods or process improvement;
Only one site perceived any improvement, but had little measurable evidence of changes in
processes or outcomes;
Only four services in the sample had been able to involve physicians;

and

Most programmes had dwindled due to personnel turnover, restructuring, too few resources and
poor programme management.
Approaches could be used to improve quality and patient safety:
Increasing resources: It is important to increase the financing, personnel, facilities or equipment
used in a hospital or health system, with the aim of treating more patients or treating the same
number faster, better and at lower cost-per-person.

61 | P a g e

Large-scale reorganization or financial reform: changing the structure of a hospital or health

system so as to facilitate better decision-making or use of resources. Changes in financing
methods are made as a way of improving quality.
Strengthening management: improving quality by increasing management responsibilities,
authority or competencies. It is sometimes used as part of other types of strategy.
Standards and guidelines: formulating standards of what is expected from health providers,
communicating, providing training in, and enforcing the standards. Most medical and clinical
audits fall within this category, as well as some approaches called quality assurance and
clinical pathways.

Patient empowerment and rights: giving patients a voice, like- through complaints systems or
patient satisfaction questionnaires, as well as publicizing what patients have a right to expect.
There may also be methods to strengthen patient power through legal entitlement, advocacy or
other institutions, such as a right to treatment within 30 minutes of arriving at an emergency
room.
Quality management system: defines responsibilities for quality and puts into place the
structures and systems to ensure it.
Quality assessment and accreditation, internal or external: There are many assessment
systems. Accreditation systems differ in which aspects of hospital operations are assessed and
whether quality outcomes are considered in the assessment.

ACCREDITED by

National Accreditation Board for

Hospitals & Healthcare Providers

National Accreditation Board for

Testing & Calibration Laboratories

The evidence about hospital quality strategies

There is no conclusive evidence of effectiveness for any of the strategies. There is some evidence
from surveys of providers expectations or perceptions of results, and some descriptive evidence

62 | P a g e

of strategies, although most of the latter are self-reports. This search found evidence of different
types for each type of strategy. Those are as follows:
Systematic reviews: There are no systematic reviews of hospital quality strategies, but there are
some reviews of interventions which could be used as part of a strategy. Distributing educational
materials to professionals has little effect, according to one review, but other reviews suggest that
this approach is more effective if combined with audit and feedback, computerized prompts or
academic detailing. Other single studies support the value of combined approaches.
Increasing resources: There is some evidence that increasing resources can reduce waiting times,
but there are disagreements about whether the reductions were due to the extra resources and
whether waiting times should be considered a quality characteristic at all. There is some evidence
that reducing resources does affect quality.
Standards or guideline strategies are simple, easily understood and largely accepted, but are quite
resource intensive and standards may be formulated without regard for resource requirements or
variations in settings. This and failure of management supervision, action or sustainability can
lead to loss of credibility.
Patient empowerment and rights: There is no evidence supporting any strategy of this type.
There is no strong evidence of the impact or costs of patient satisfaction questionnaires.
It noted the effort and costs to create these results, the publication bias of the journals, and that
evidence has yet to emerge of an organization-wide impact on quality. CQI-based improvement
programme explained the wide range of short-term and long-term results as due to the power of
physicians. Recommendations included stimulating change at individual, team, organization and
systems levels simultaneously and pointed out the need for personnel to feel that they, too, as well
as patients, benefit from improvements.
Re-engineering: There is no evidence of a hospital wide re-engineering programme. There are
some early reports of successful projects using this approach but the full costs and benefits were
not reported. The best scientific study- re-engineering strategy found some benefits but also
reported the importance and difficulty of getting continual support from doctors.
This finding is echoed on many studies of different strategies.

63 | P a g e

 Evidence- one type of strategy is better than another for improving quality and
patient safety
There is no scientific evidence that one type of strategy is better than another. There is little
research assessing the effectiveness of one or more hospital or national quality strategies. The lack
of evidence is largely a result of the difficulties of evaluating this type of intervention and of
proving that the results are due to the strategy and not to other changes.
There are many publications and reports describing different strategies, but few report valid
evidence of results. There is an even larger body of literature by consultants, academics and
commentators advising on the best approach, some of which is based on sound experience, but
little is based on scientific research. In sum, no one quality strategy can be recommended over
another on the basis of evidence of effectiveness, ease of implementation or costs.
Graphical representation of satisfaction after getting quality service

We have improved our quality & continuously trying to improve that. We estimated the result &
able to make the presentation from patient feedback from, collected from Public Relation
department.

64 | P a g e

CHAPTER 7

RECOMMENDATION
Little useful, accessible scientific research has been undertaken into the effects of hospital
quality strategies. Some research has been carried out that is helpful for identifying,
planning and implementing an appropriate strategy.
There are some reviews of interventions such as guideline implementation suggesting that
multiple strategies are more likely to be successful. No evidence exists to suggest one
best strategy. This overview of the available research suggests that a strategy is more
likely to be successful if it is chosen with knowledge of alternative approaches, adapted to
the situation, reviewed and adjusted to changes and pursued consistently by committed
management. It is possible that a policy and financial context that rewards greater safety
and quality is important, as is active and transparent management of the balance of
quantity, cost and quality of service.
Control Plan:

Sustained efforts are required from all stakeholders to maintain and the
further improve the target.

Fine twinning of processes to achieve better results.

Non-controllable factors from control impact matrix have to be worked on

to achieve ideal results.

Total Quality Approach

This framework can be used for improving our quality approach in providing services.
This technique can be used to bring changes in TQM.

65 | P a g e

PROJECT STAGES
Statement of intent

KEY OBJECTIVES
Communicate intention to change

Awareness

Educate management in total quality

Diagnosis

Identify& priorities key issues to be

addressed through quality

Initial Strategy

Management
consensus
Launch

Above the six key concepts

Plan for the six elements of
management framework

Brief all managers & agree

strategies
Ensure the management actions
are consistent
Involve & train all the staffs
Begin to manage the business
under a new framework
Total Quality Approach

66 | P a g e

 Policy options
The main recommendations from this synthesis of the literature are based on a few valid
outcome studies and a critical assessment of the descriptive literature.
We should decide which approach to adopt after making an assessment of quality
and safety status and listing the different strategies which might be appropriate to
situation.
We should recognize the value of extensive experience as a form of evidence, but
also the commercial nature of the growing quality industry in health care.
Attention needs to be paid to financial, cultural and other conditions surrounding
implementation.
Having chosen one type of quality strategy, one should review it regularly and
adapt it to changing situations and the responses of the interested personnel.
Efforts should be made to assess whether any lack of results is due to the wrong
strategy, poor implementation, or the time required for results to become
measurable. Close monitoring using a range of types of information can assist this
assessment.
It is possible that applying a consistent quality strategy over time is more likely to
be effective than changing to another approach. Flexibility without sudden radical
change appears to be important.
Quality experts with wide experience can be useful, but need to be chosen with
care. One or more independent experts should be used to give independent
feedback for regular reviews of a strategy.
Our quality strategies should include improving inter-service quality for different
patient groups, such as older people, and address hospital-community
coordination of care issues.
Patient experiences and outcomes are affected by how hospitals provide access,
outreach and linking with non-hospital services in systems of care.
We need to pay more attention to describing the strategy actually carried out,
assessing the depth of implementation, and considering alternative explanations
for the apparent results of a strategy.

67 | P a g e

 Fuller reviews of the evidence for particular strategies identified in this report
should be carried out.
If the organization uses, among others, also operations management knowledge then there
is a high probability of achieving its set goals. It means the organization will also reach a
high competitiveness and it will be able to maintain it.
It is probable for the organization to obtain even a greater competitive advantage over
other entities if there has been implemented also the system of ecological management,
EMS. The EMS enables companies to check their impact on the environment. The main
components of every EMS are ecological policy, a systematic approach in planning,
initial and operational management, correcting and control mechanisms including regular
audits and regular inspections of management.

Benchmarking:
Since benchmarking is the constant process of evaluating services and practices it can be
used by organisations searching for best practises that lead to outstanding performance. It
is only through a change of current practises or performing our processes that
effectiveness can improve.

68 | P a g e

BENCHMARKING PROCESS MODELS

Auditing
It is also an important process for quality improvement. The purpose of the audit is
determination of compliance or identification of opportunities for improvement. A system
is a group of processes or elements linked to achieve a common purpose. The scope of an
audit may be the complete management system of a facility or a portion or a subsystem.
An audit scope can be one of the support processes in quality department. Various
processes for doing successful auditing are mentioned as follows:

69 | P a g e

Audit performance
Verification of facts
Discovery of causes
Recommendation & remedies
Status of the audit
Audit reporting
Review audit result
Audit details
System effectiveness
Conclusion to be reported
Request for corrective actions
Stage of evaluation
Scope of the service audit
Sampling for service audit
Reporting the results of audit
Graphical presentation of percentage in maintainence the quality in records
keeping (recommendation)

70 | P a g e

CHAPTER 8

CONCLUSION
Medica Supersapcialty Hospital tries to upgrade with the new upcoming ideas to face the
new challenges in the health care scenario. The rapid development of state-of the art of
ideas has brought sweeping changes in the health care scene.
The policies and procedure used by the management is really fruitful to the company in
generating revenue. The department in charge taking idea from quality department is
responsible to measure the increase in productivity with the implementation of new ideas.

71 | P a g e

BIBLIOGRAPHY
[1] K.Shridhara Bhat, Total quality management (text and cases), 4nd edition.
Himalaya publishing, India 2007, ch-1, 3,6, 8,9,17.
[2] R.P. Mohanty & R.R. Lakhe, TQM in service sectors, 2nd edition. Jaico publishing,
India-2006, pp-340-396
[3] James R. Evans and James W. Dean, TQM organization, and strategy, 2nd edition.
South-western,Thomson learning publishing, Singapore-2002, pp:5-30
[4] http://www.ge.com/en/company/companyinfo/quality/whatis.htm
(5] J. B. Dilworth. Operations Management. Design, Planning, and Control for
Manufacturing and Service. McGraw-Hill, 1992.
[6] L. Galloway, F., Rowbotham, F., M. Azhashemi. Operations Management in Context.
Elsevier Butterworth- Heinemann, 2005.
[7] H. Hrzov. Operations Management Syllabus. VE v Praze, 1999.
[8] N. Slack, S. Chambers, C. Harland, A. Harrison, and R. Johnston. Operations
Management. Pearson Education, 2004.
[9] G. Tomek, V. Vvrov, V. zen vroby. Grada Publishing, 2000.
[10] Leape L. Error in medicine. Journal of the American Medical Association, 1994,
272; 23:1851-57.
11] IOM. To err is human. Washington, National Academy Press, 1999.
12] Coulter A, Magee H. The European patient of the future. Milton Keynes: Open
University Press, 2003.
13] Mossialos E. Citizens views on health systems in the 15 member states of the
European Union. Health Economics, 1997, 6:109-116.
14] vretveit J. What are the advantages and constraints of the different quality tools for
European hospitals? A review of research and policy issues. Health Evidence Network
report. Copenhagen, World Health Organization, 2004 (in preparation).
15] Scott T et al. Organizational culture and performance in the NHS: a review of the
theory,instruments and evidence. York, Centre for Health Economics, 2001.

72 | P a g e

16]

Grimshaw J et al. Systematic reviews of the effectiveness of quality improvement

strategies and programmes. Quality and safety in health care, 2003, 12:298-303.
17] Department of Health. National service framework for coronary heart disease;
modern standards and service models. London, HMSO, 2000.

73 | P a g e

ANNEXURES

74 | P a g e

75 | P a g e

76 | P a g e

77 | P a g e

Some successful story in our hospital

CRT post valve replacement: A challenge well met!
Dr. Dilip Kumar, Sr Interventional Cardiologist at Medica, recently conducted an unusual
procedure on a 53-year-old male patient. The person was a post valve replacement patient, having
undergone Aortic Valve Implantation in 2006. However, when the patient came to Medica in end
April, he was showing symptoms of heart failure. He complained of constant fatigue, limited
mobility and shortness of breath. He was also struggling with psychological problems like low
confidence, anxiety and tension, which had greatly compromised his quality of life.
After an initial assessment Dr. Kumar suggested Cardiac Resynchronisation Therapy. The surgery
was performed successfully on 3rd May 2012. Just 24 hours post surgery, the patient started
showing increase in functional capacity. He soon became ambulatory with no signs of shortness
of breath and fatigue. His overall condition has shown a significant improvement. Very soon he
got be able to resume all his normal activities including his professional work.
For Dr. Kumar, this was a very challenging case. This was the 3rd such case performed at MSH.
Live surgery for tremor (essential and Parkinson disease)
Live surgery was performed for tremor (essential and Parkinson disease), by the renowned neuro
surgeons along with MIND Director Dr. Tripathy and his team. The surgery was performed on a
53-year-old woman who has been suffering from Parkinsons for the past 10 years. The patient
had severe tremor in the right side of her body. Doctors installed a neurostimulator, known as
Deep Brain Stimulation (DBS) to provide electrical stimulation to targeted areas of the brain that
control movement and block abnormal nerve signals causing severe tremor. Post surgery the
patient was completely cured of her symptoms.

78 | P a g e