CHAPTER ONE

INTRODUCTION
The purpose of this project is to look at the history of Total Quality Management (TQM)
and identify the elements that are within this business improvement tool. With these
key elements we will then be looking at how TQM is used within the current business
environment and how it elements affect all levels of an organization.
TQM is the way of managing for the future, and is far wider in its application than just
assuring product or Service quality it is a way of managing people and business
processes to ensure complete customer Satisfaction at every stage, internally and
externally. TQM, combined with effective leadership, results in an Organization doing
the right things right, rst time.
The core of TQM is the customer-supplier interfaces, both externally and internally,
and at each interface lay a number of processes. This core must be surrounded by
commitment to quality, communication of the quality message, and recognition of the
need to change the culture of the organization to create total quality. These are the
foundations of TQM, and they are supported by the key management functions of
people, processes and systems in the organization.
This section discusses each of these elements that, together, can make a total quality
organization. Other Sections explain people, processes and systems in greater detail,
all having the essential themes of Commitment, culture and communication running
through them.

1.1 Background of the study

Many business processes, important things should be maintained by the company to
insure quality of product is to control the good quality of product in any business
process. In any business key aspect is quality of product, so every company first
maintains quality of product. This study is basically about TQM and how TQM can be
applied in hospital services quality improvements. Also discuses about the different
strategies of TQM and application and what are the impacts of TQM in hospital service.

1.2 Statement of problem

TQM is based on the participation of all members of an organization in improving
processes, products, services and culture in which they work. But many companies
have implemented TQM, but not all company can practices this quality management
system successfully. Hospital is one of a service delivery organization which tries to
implement TQM concept to improve quality of services to the customer. While TQM is
widely used in Ethiopia, but most of the company such as hospital service did not fully
implement the concept of TQM due to limited knowledge about the whole TQM concept
and lack of enforcement from the top management and lack of involvement of the
employee.

1.3 OBJECTIVE
The general objective of the study is to improve efficiency of hospital service TQM
approach.
The specific objective of study is:

Explain the meaning and advantage of total quality management (TQM)

To ensure customer satisfaction

Continuous improvement as a culture of organization

Describe tools for identifying and solving quality problem

To develop a conceptual understanding of the basic principles and methods

Associated with TQM;

To develop an understanding of how these principles and methods have beenput

into effect in a hospital;

To develop an understanding of the relationship between TQM principles and the

theories and models studied in traditional management;

To do the right things, right the first time, every time.

1.4 Methodology
Research methodology of this project involves a number of different work tasks that are
performed to lead quality services. First by describe the statement of the problem and
define the objectives of the research. This is followed by the literature review where all
2

the relevant information regarding the total quality management system is gathered. We
gathering informations through such questions:
1

What types of service customer can get?

How customer served?

What types of complains raised by the customers?

Does the hospitals enough employers?

Do customers satisfy?

What are the root cause that leads to rise the customer complain?

Do a customer served on time?

Are the employers honest and punctual?

Is drug serves have quality?

10

Is there smooth relationship between customers and employers?

1.5 Limitation of the study

The following problems are faced during the project: No adequate works, reference
books, gathering informations and materials are in place. The workers are not fully
voluntary to give useful information or they do not answer our questionnaires properly
as we need from them. The time given for the project work was not adequate enough to
supplement the study exhaustively and hence the given project is not given as
specifically and it became huge to study each of the given services. It would rather
serve as a spring board for further studies in the area. Internet service is also one of the
limitations.

CHAPTER TWO
Literature review
2.1 What is quality?
Today, there is no single universal definition of quality. Some people view quality as
performance to standards. Others view it as meeting the customers needs or
satisfying the customer.
Lets look A frequently used definition of quality is Delighting the customer by fully
meeting their needs and Expectations. These may include performance, appearance,
availability, delivery, reliability, maintainability, cost effectiveness and price. It is,
therefore, imperative that the organization knows what these needs and expectations
are. In addition, having identified them, the organization must understand them, and
measure its own ability to meet them.
Quality starts with market research to establish the true requirements for the product
or service and the true needs of the customers. However, for an organization to be
really effective, quality must span all functions, all people, all departments and all
activities and be a common language for improvement. The cooperation of everyone at
every interface is necessary to achieve a total quality organization, in the same way that
the Japanese achieve this with companywide quality control. Some of the more
common definitions of quality.

Conformance to specifications:-How well a product or servicemeets the

targets andtolerances determined by itsdesigners.

Fitness for use:-A dentition of quality thatevaluates how well theproduct

performs for itsintended use.

Value for price paid:-Quality dened in terms ofproduct or service usefulnessfor

the price paid.

Support services:-Quality dened in terms ofthe support provided afterthe

product or service ispurchased.

Psychological criteria:-A way of dening quality thatfocuses on

judgmentalevaluations of whatconstitutes product or serviceexcellence.
4

2.2TOTAL QUALITY MANAGEMENT

Total Quality Management (TQM) is an initiative which aims to involve every member of
an organization, at all levels, in improving the standard of product or services that they
provide.
Total Quality Management centered on quality and based on the participation of
everybody which aims at the customer satisfaction and at the improvement of the
company's personnel, of the company and of the society.

2.3HISTORY OF TQM
Total Quality Management (TQM) is a management approach that originated in the
1950s and has steadily become more popular since the early 1980s. Total quality is a
description of the culture, attitude and organization of a company that strives to provide
customers with products and services that satisfy their needs. The culture requires
quality in all aspects of the companys operations, with processes being done right the
first time and defects and waste eradicated from operations.
Concepts developed in Japan beginning in the late 1940's and 1950's, pioneered there
byAmericans Feigenbum, Juran and Deming set the foundations of TQM. The evolution
of TQM happened in a few stages easily identified as Inspection, Quality Control,
Quality Assurance and now Total Quality Management.

2.4 The Eight Elements of TQM

To be successful implementing TQM, an organization must concentrate on the eight key
elements:
1

Ethics

Integrity

Trust

Training

Teamwork

Leadership

Recognition

Communication
5

These elements can be divided into four groups according to their function. The groups
are:
2.41 Foundation It includes: Ethics, Integrity and Trust.
2.4.2 Building Bricks It includes: Training, Teamwork and Leadership.
2.4.3 Binding Mortar It includes: Communication.
2.4.4. Roof It includes: Recognition.
2.4.1 Foundation
TQM is built on a foundation of ethics, integrity and trust. It fosters openness, fairness
and sincerity and allows involvement by everyone. This is the key to unlocking the
ultimate potential of TQM. These three elements move together, however, each element
offers something different to the TQM concept.

1. Ethics Ethics is the discipline concerned with good and bad in any situation. It is a
two-faceted subject represented by organizational and individual ethics. Organizational
ethics establish a business code of ethics that outlines guidelines that all employees are
to adhere to in the performance of their work. Individual ethics include personal rights or
wrongs.

2. Integrity Integrity implies honesty, morals, values, fairness, and adherence to the
facts and sincerity. The characteristic is what customers (internal or external) expect
and deserve to receive. People see the opposite of integrity as duplicity. TQM will not
work in an atmosphere of duplicity.

3. Trust Trust is a by-product of integrity and ethical conduct. Without trust, the
framework of TQM cannot be built. Trust fosters full participation of all members. It
allows empowerment that encourages pride ownership and it encourages commitment.
It allows decision making at appropriate levels in the organization, fosters individual risktaking for continuous improvement and helps to ensure that measurements focus on
improvement of process and are not used to contend people. Trust is essential to
ensure customer satisfaction. So, trust builds the cooperative environment essential for
TQM.

2.4.2Bricks
basing on the strong foundation of trust, ethics and integrity, bricks are placed to reach
the roof of recognition. It includes:
4. Training Training is very important for employees to be highly productive.
Supervisors are solely responsible for implementing TQM within their departments, and
teaching their employees the philosophies of TQM. Training that employees require are
interpersonal skills, the ability to function within teams, problem solving, decision
making, job management performance analysis and improvement, business economics
and technical skills. During the creation and formation of TQM, employees are trained
so that they can become effective employees for the company.
5. Teamwork To become successful in business, teamwork is also a key element of
TQM. With the use of teams, the business will receive quicker and better solutions to
problems. Teams also provide more permanent improvements in processes and
operations. In teams, people feel more comfortable bringing up problems that may
occur, and can get help from other workers to find a solution and put into place. There
are mainly three types of teams that TQM organizations adopt:
A. Quality improvement teams or excellence teams (QITs) These are temporary teams
with the purpose of dealing with specific problems that often recur. These teams are set
up

for

period

of

three

to

twelve

months.

B. Problem solving teams (PSTs) These are temporary teams to solve certain
problems and also to identify and overcome causes of problems. They generally last
from

one

week

to

three

months.

C. Natural work teams (NWTs) These teams consist of small groups of skilled workers
who share tasks and responsibilities. These teams use concepts such as employee
involvement teams, self-managing teams and quality circles. These teams generally
work for one to two hours a week.
6. Leadership It is possibly the most important element in TQM. It appears
everywhere in organization. Leadership in TQM requires the manager to provide an
inspiring vision, make strategic directions that are understood by all and to instill values
that guide subordinates. For TQM to be successful in the business, the supervisor must
be committed in leading his employees. A supervisor must understand TQM, believe in
7

it and then demonstrate their belief and commitment through their daily practices of
TQM. The supervisor makes sure that strategies, philosophies, values and goals are
transmitted down throughout the organization to provide focus, clarity and direction. A
key point is that TQM has to be introduced and led by top management. Commitment
and personal involvement is required from top management in creating and deploying
clear quality values and goals consistent with the objectives of the company and in
creating and deploying well defined systems, methods and performance measures for
achieving those goals.

2.4.3 Binding Mortar

7. Communication It binds everything together. Starting from foundation to roof of the
TQM house, everything is bound by strong mortar of communication. It acts as a vital
link between all elements of TQM. Communication means a common understanding of
ideas between the sender and the receiver. The success of TQM demands
communication with and among all the organization members, suppliers and customers.
Supervisors must keep open airways where employees can send and receive
information about the TQM process. Communication coupled with the sharing of correct
information is vital. For communication to be credible the message must be clear and
receiver must interpret in the way the sender intended.
There are different ways of communication such as:
A. Downward communication This is the dominant form of communication in an
organization. Presentations and discussions basically do it. By this the supervisors are
able to make the employees clear about TQM.
B. Upward communication By this the lower level of employees are able to provide
suggestions to upper management of the affects of TQM. As employees provide insight
and constructive criticism, supervisors must listen effectively to correct the situation that
comes about through the use of TQM.
C. Sideways communication This type of communication is important because it
breaks down barriers between departments. It also allows dealing with customers and
suppliers in a more professional manner.

2.4.4 Roof
8

8. Recognition Recognition is the last and final element in the entire system. It
should be provided for both suggestions and achievements for teams as well as
individuals. Employees strive to receive recognition for themselves and their teams.
Detecting and recognizing contributors is the most important job of a supervisor. As
people are recognized, there can be huge changes in self-esteem, productivity, quality
and the amount of effort exhorted to the task at hand. Recognition comes in its best
form when it is immediately following an action that an employee has performed.
Recognition comes in different ways, places and time such as,
1

Ways It can be by way of personal letter from top management. Also by award
banquets, plaques, trophies etc.

Places Good performers can be recognized in front of departments, on

performance boards and also in front of top management.

Time Recognition can give at any time like in staff meeting, annual award
banquets, etc.

Total Quality Management Benefits:-The ManagerCty/Organizational Excellence

Handbook identifies the following direct and indirect benefits that total quality
management (TQM) can offer organizations:
1

Strengthened competitive position

Adaptability to changing or emerging market conditions and to environmental

and other government regulations

Higher productivity

Enhanced market image

Elimination of defects and waste

Reduced costs and better cost management

Higher profitability

Improved customer focus and satisfaction

Increased customer loyalty and retention

10

Increased job security

11

Improved employee morale

9

12

Enhanced shareholder and stakeholder value

13

Improved and innovative processes

2.5 TQM Implementation Approaches

You can't implement just one effective solution for planning and implementing TQM
concepts in all situations. Below we list generic models for implementing total quality
management theory:
1- Train top management on TQM principles.
2- Assess the current: Culture, customer satisfaction, and quality management system.
3- Top management determines the core values and principles and communicates
them.
4- Develop a TQM master plan based on steps 1, 2, 3.
5- Identify and prioritize customer needs and determine products or service to meet
those needs.
6- Determine the critical processes that produce those products or services.
7- Create process improvement teams.
8- Managers support the efforts by planning, training, and providing resources to the
team.
9- Management integrates changes for improvement in daily process management.
After improvements standardization takes place.
10- Evaluate progress against plan and adjust as needed.
11- Provide constant employee awareness and feedback. Establish an
employee reward/ recognition process.

2.6 IMPLEMENTATION AREA OF TQM

TQM can be implemented successfully in any part of a business, such as
1

Accounting

Finance

Legal and administration

10

Manufacturing

Materials management

Research and development

2.7 PRINCIPLES OF TQM

1- Be Customer focused: Whatever you do for quality improvement, remember that
ONLY customers determine the level of quality. Whatever you do to foster quality
improvement, training employees, integrating quality into processes management,
ONLY

customers

determine

whether

your

efforts

were

worthwhile.

2-Insure Total Employee Involvement: You must remove fear from work place, then
empower employee... you provide the proper environment.

3- Process Centered: Fundamental part of TQM is to focus on process thinking.

4- Integrated system: All employees must know the business mission and vision.
5- Strategic and systematic approach: Strategic plan must integrate quality as core
component.
6- Continual Improvement: Using analytical, quality tools, and creative thinking to
become more efficient and effective.
7- Fact Based Decision Making: Decision making mustbe ONLY on data, not
personal or situational thinking.
8- Communication: Communication strategy, method and timeliness must be well
defined.
11

2.8 Strategies to develop TQM

1-TQM elements approach: Take key business process and use TQM Tools to faster
improvement. Use quality circles, statistical process control, taguchimethod, and quality
function deployment.
2 - The guru approach: Use the guides of one of the leading quality thinker
3- Organization model approach: The organization use benchmarking as model for
excellence
4- Japanese total quality approach: Companies pursue the Demingprize
use Demingprinciples
Evolution of Thinking: TQM
The highest quality level is made of four main elements:
1) Focus on the customers
(Fitness to use or to latent requirements)
2) Continuous improvement
(Fitness to standard and of cost)
3) Total participation
4) Societal Networking
Let us review these 4 elements successively
1

Focus on the customers

The customer ultimately determines the level of quality. No matter what an

organization does to foster quality improvementtraining employees, integrating
quality into the design process, upgrading computers or software, or buying new
measuring toolsthe customer determines whether the efforts were worthwhile.
Recommend each worker / employee / department to raise the following questions:
1. Who are my customers?
2. What are their needs?
3. What is my product or service?
4. What are my customers' measures or expectations?
5. What is my process for meeting their needs?
12

6. Does my product or service meet these needs?

7. What actions are needed to improve my process?
2) Continuous improvement
To improve a product/process is not obvious. A methodology is necessary. Here is the
oneCalled "the seven quality control (7QC) steps" that is made, oh wonder, of 7 steps.
1. Select a theme
First, we should determine the problem on which we will concentrate. Formulating the
theme as a weakness helps to state the theme as a problem not as a solution.
2. Collect and analyze data Use: Check sheets, Histogram, Pareto diagram
After the theme has been stated, one should not hurry for solutions. The first thing to do
is to consider the reality again by collecting data related to the selected theme.
Check sheets, histograms, Pareto diagrams and scatter diagrams are all QC toolswhich
help collecting and analyzing the data.
3. Analyze causes
Use: Cause-and-effect diagram
The goal here is to go back to the root cause of the problem. A classical tool for finding
the
Root cause is the cause-and-effect diagram which addresses all types of problem/error
Sources: man, process, material and environment.
4. Plan and implement solution
The next step is to find a remedy to the root cause. Solution could be tested on a small
sample. Other remedies could be tried.
5. Evaluate effects
Again, before implementing the solution on a large scale, one should check the effect of
this
Remedy in the real life. Only when it shows to be effective, it can be standardized.
6. Standardize the solution
At this point, the improvement is implemented on a regular basis.
7. Reflect on process and the next problem
Here some reflections about the improvement process are necessary. Maybe, some
Systematic checks should be incorporated. Maybe, a better data collection system
should be used.
3) Total participation
13

If we want the continuous improvement to take place, we should let the workers do it.
Continuous improvement is a worker's task
The workers are usually more competent than the managers to improve the system.
What workers want?
Here is a list of the most desired features.
- Goals which are clear, challenging and reachable
- Means to reach the goal
- Responsibility for the outcome
-Information about the corporate goals
-Participation in decisions
-Salary
- Job security
- Interesting work
-Self-development
And most of these features must be granted if you want a continuous improvement
system.
4) Societal Networking
The TQM mentality also assumes that your company positively interacts with the
"society" in
Which it operates.
- National promotional organization
- Training
- Knowledge dissemination
- Societal promotional activities
-national standard certification
- Development of new methods
2.9 TQM Tools and Technique

Total Quality MANAGEMENT involves the use of several quality control tools and
techniques. The Performance of Quality Control process of the Project Quality
Management knowledge area has several quality control tools and techniques that are
14

also used in the Performance TOTAL Quality control process. There are many quality
control techniques and the cause and effect techniques discussed in this project.

2.9.1 Cause-And-Effect Diagram

A Cause-and-Effect Diagram is a tool that helps identify, sort, and display
Possible causes of a specific problem or quality characteristic. It graphically illustrates
the relationship between a given outcome and all the factors that influence the outcome.
This type ofdiagram is sometimes called a "fishbone diagram".

15

CHAPTER THREE
DATA COLLECTION AND ANALYSIS
Introduction
In our project we take Debremarkos referral hospital as our research center
thatfocused how to improve hospital quality by using TQM. It found on the
southern part of Debre Markos town. This hospital works for 24- hours per a day
to give medical treatment for patients.
Debre Markos Referral Hospital is working in corporation with I-Take Ethiopia to give
service for customers, in order to fulfill satisfaction. There are different types of
customer services such as;

pharmacy service

Surgical service

Laboratory service

Emergency service

Dental service

Mid wafers service

Ultrasound service

HIV treatment service

Healthy service and etc.

3.1. Vision of the hospital

Debre Markos Referral Hospital strives to be the premier and recognized hospital
nationwide in provision quality of health care.

3.2. Mission of the hospital

The mission of the debre Markos hospital is to provide all patients quality accesses
able and cost effect health care.
We aspire to:
1

providing an excellent standard of service for all customers

delivering health service in line with the socio-economic status nearby customers

developing our skill, knowledge to serve our clients

continuously build up our service to meet clients interest

16

enabling the hospital to be a comfortable working environment

3.3

Core Values Of The Hospital

Community first:
- treat the mass would like to be treated
-for nothing but to serve and satisfy the community
-have priority for community continued medical education

Trust: to ensure maximum vulnerability and integrative to each other

collaboration: work together inspire to mutual support and understanding to

achieve hospital collective goal

Commitment: no matter what challenge we feel we stand firm, be patient and

exert our sustained effort to achieve our goals.

change: innovate new ways of doing things and be open

We hope that Quality Management for Health Care Delivery will help physicians,
nurses, administrators, and others begin discussing, preparing and implementing the
changes. Quality Management for Health Care Delivery provides a framework to help
hospitals organize for, communicate about, monitor, and continuously improve all
aspects of health care delivery. It also presents evidence to support the proposition that
an organized system to achieve high quality care can lead to lower health care costs.
3.4

Model for Quality Management in Hospitals

Early in its deliberations the Quality Measurement and Management Project (QMMP)
task force of system and alliance representatives identified the lack of a common
context and framework for quality discussions among care givers, health care
managers, and others as a key unmet need in hospitals. Two products are required to
address this need:
A continuous quality improvement model that will help hospitals develop a top-down,
organization-wide commitment to quality management and improvement.
A quality assurance model setting a common approach to quality assurance utilization
review risk management and infection control within hospitals. Continuous quality
improvement programs are nearly always built on the foundation of good ongoing
quality review.
17

A functional description of quality :While many approaches to understanding

quality are available, the task force selected that used within continuous quality
improvement (CQI) theory. That particular description is useful because
(a) It clearly delineates the close relationship between quality and cost, and
(b) It leads to a system for coordinated quality/cost control. In particular, it shows how
the pursuit of high quality in healthcare can lead to substantially lower health care costs.
Using CQI concepts, quality may be described as follows:
A 'health care delivery system' is a series of interlinked processes, each of which
results in one or more outputs. 'Quality' represents an individual's subjective evaluation
of an output and the personal interactions that take place as the output is delivered to
the individual. It is rooted in that individual's expectations, which depend upon the
individual's past experiences and needs. Quality evaluations therefore arise from and
are part of, an individual's value system. As a value system, quality expectations can be
measured and changed over time through education. Although patients and payors are
playing an increasingly active role in evaluating medical content quality, it has
traditionally been the province of physicians and other health care professionals.
Delivery quality reflects an individual customer's interaction with the health care system
for a patient. Was the hospital clean? Were the nurses caring and informative? Were
services delivered rapidly, carefully, and with understanding of the patient's individual
needs and preferences?
A 'customer' is any individual who makes a quality judgment regarding any output or
sub output produced by a health care process, or the personal transaction in which the
output was delivered.
Value of Care: The following five areas are considered:
Physical infrastructure: Issues include technology assessment, system integration, and
other long-term questions regarding maintenance of a high quality physical plant,
without these consideration high quality health care is impossible.
Professional infrastructure: High-quality health care depends upon the presence of
well-trained, dedicated, health care professionals and managers. Most traditional quality
assurance efforts have concentrated on maintaining this important area.

18

 Decision to treat: Inappropriate diagnosis can lead to unnecessary hospitalization and

treatment. Recent research suggests that, within some diagnoses and procedures, a
substantial proportion of
health care interventions are inappropriate. Inappropriate therapy wastes resources and
damages patientsit is an almost perfect example of quality waste and is of particular
importance to health care financiers.
Manner of treatment:

Many studies have demonstrated a very large amount of

variation in resource utilization to achieve comparable results for particular diagnoses

and procedures. Inappropriate variation, when identical outcomes are obtained, is an
excellent example of productivity waste.
Productivity waste (low productivity) is an important issue for health care financiers
and for those areas in which hospitals are at risk for resource utilization (e.g., the DRG
prospective pricing system and other managed care plans).
Avoid/mitigate errors:

The health care delivery process is extremely complex.

Research has shown that human beings and their systems are imperfect information
processors-regardless of intention or human attention, mistakes will occur with
increasing regularity as complexity increases. Systems which concurrently monitor the
health care process, detect errors, and correct them before damage occurs will be
vitally important in the future

3.5 Obstacles associated with TQM Implementation IN HOSPITAL

Lack of management commitment
Inability to change organizational culture
Improper planning
Lack of continuous training and education
Incompatible organizational structure and isolated individuals and departments
Ineffective measurement techniques and lack of access to data and results.
Paying inadequate attention to internal and external customers.
Inadequate use of empowerment and teamwork

3.6 Customer Complains

The customers or users provide the following complains in debremarkos referral hospital from
some employers, such as:

19

do not get fast service on time

lack of fair payment

do not get good governance (management) from the employer

lack of skilled employer (worker)

does not give enough awareness

deficiency (shortage) of drugs distribution

no enough access of ambulance service

No more advanced technology

3.7

Customer satisfaction

Debre Markos referral hospital is working for 24 hours to satisfy the customer needs,
to ensure quality and to prefers hospitals from other. Then to do so it gives the following
satisfaction: It gives service for every one without any difference
1

It gives free service for some selected diseases

The customers treat every time without going to far distances

It gives bed room ,food,toilet,tea and recreation services inside the hospital

Customer gets many services(diseases treatment)

Customer provides more or less by skilled senior doctors

3.8 Benefits of Using a Cause-and-Effect Diagram

A Cause-and-Effect Diagram is a tool that is useful for identifying and organizing the
known orpossible causes of quality, or the lack of it. The structure provided by the
diagram helps teammembers think in a very systematic way.
Some of the benefits of constructing a Cause and Effect Diagram:
Helps to determine root causes
Encourages group participation
Uses an orderly, easy-to-read format
Indicates possible causes of variation
Increases process knowledge
Identifies areas for collecting data

20

Method
Specification

conveyor speed
layout of design

Worker
Tight
tolerances

Variation
among workers

Inadequate
trainging

Effect: Poor
solder joints

Solder bit too

large
Temprature of
solder bit

Equipment

Process
capability

Improper
flux

Insufficient
solder

Materials

Process

Figure: Cause and Effect Diagram

21

CHAPTER FOUR
Discussions & Result
4.1 problems and solutions

4.1.1 Lack of skill employees:

One of the problem for debreMarkos referral hospital is it does not have professional
or skilled workers, so to improve this quality the hospital must have to be employee
sinner doctors to give good service for customers. And the hospital management must
provide a chance to get the workers additional or supportive educations.

4.1.2 Lack of good management:

The management problem is another factor for the quality of the hospital; to
improve this manager of the hospital must be manage the whole society of
the hospital effectively, without any discrimination, violation of right,
corruptionetc. Also the management must initiate the employees by
providing a reward the one who works hard, this leads the employees to
become competitive with each other.
4.1.3 Lack of advance technology
It is one of the prominent causes for poor quality of service in debre
Markos referral hospital, since technology play great role to ensure quality
of the hospital by identification of the diseases. To improve this
hospitalmust have to be used advanced technology with co-operation with
other health center organization.
4.1.4 Lack of access of drug
Shortage of drug is the factor of the reduction of quality of the service,
since the hospital sends the patients to the private center clinics to
get the drug. To avoid this hospital have to be work with the drug

22

manufactured (provider) organizations other than sending patients to

another clinic or hospital.
4.1.5 Lack of using TQM implementation techniques
Must use quality control tools and techniques to solve the problem especially
cause and effect diagram toidentify the major factor that affects the total quality of
the hospital.A Cause-and-Effect Diagram is a tool that helps identify, sort, and
display possible causes of a specific problem or quality characteristic of the
hospital. The diagram graphically illustrates the relationship between a given
outcome and all the factors that influence the outcome.
It is used when we need to:

Identify the possible root causes, the basic reasons, for aspecific effect,
problem, or condition of hospital.

Sort out and relate some of the interactions among the factors affecting a
particular process or effect in hospital.

Analyze existing problems so that corrective action can be taken to

improve efficiency of hospital.

23

24

CHAPTER FIVE
RECOMMENDATION AND CONCLUSION
5.1. Conclusion
Total quality management is important techniques to implement,
design, develop and evaluate quality service in an organization to
provide desired out puts of the company.
Total quality control has always been an important part of the
world's quality product, providing reliable, cost effective product,
time effect, frequency effect to ensure that the products,
services, or processes provided meet specific requirements and
are dependable, satisfactory, and will continue to do so in the future.
After performed (completed) the case study the problem of
service improving Debre Markos referral Hospital in Debre
Markos city are described discussed and solved partially.
5.2 Recommendation
1

developed the Total quality management and information available

TQM

improve and react challenges that affect the process in Total quality
management

1.

Conduct effective and qualified assessment of projects;

2.

Integrate economic, social and environmental aspects ;

3.

Maintain database hospital service

4.

Developing the working habit for effective quality management

5.

identify causes and effects of healthy service

6.

Develop sustainable management plans of health service and apply it

7.

It is better to give training for employees about the total quality

management techniques.
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REFERENCES
1

http://www.mechanicalengineeringblog.com/total-quality-control-pdf/

http://www.rajeshitmane.com/56/academics/history-of-qualitycontrol.html/

Total quality management by R.C.Gubta. Text book

Industrial Engineering and Management by*(Dr. B. KUMAR). Text

book.

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