TQM IN

HOSPITALS

BY, GROUP 6
RASHMI.S
RAHUL SHARMA
SHILPI ADHIKARY
SISIRA.S.SASI
ABHILASH IYAPPAN
 STATISTICS – SKM RAO –
MEMBER NABH
• The Healthcare business in India is the largest after Retailing.

• Global healthcare revenue US $ 2.8 trillion

• India’s healthcare industry worth US$ 17 billion; to grow by 13% per annum for next 6 years

• Medical tourism could account for 3-5% of the total healthcare delivery market.

• A study by Mckinsey estimates India can earn 5000-10,000 crore by 2012

• In 2007, around 272,000 medical tourists visited India for medical tourism and together, they
brought US$ 656 Million in revenues.

• The Indian medical tourism market is expected to generate over US$ 2.5 Billion in revenues by
2012.

• -Lack of proper hospital accreditation system and inefficient laws against malpractice are the
biggest factor limiting the growth of India's medical tourism Industry.
 FACTS !!!
• Patients are the foundation of our medical practice

• It is very obvious that they must be satisfied

• Do we always succeed?
Some experiences

Patients tell the

truth
• “Quality service? I don’t ask for much from my doctors.”
The woman, a business professional in her late 30s,
seemed pleased to be asked. “I don’t want to wait
endlessly, but I understand it if something comes up in the
schedule to cause a delay – just tell me about it! I’m much
more forgiving if someone keeps me informed”.

• “I like to feel that I have my doctor’s attention during the

visit. I don’t expect a half hour of his time, just a sense of
concern. My pediatrician is wonderful. He always
remembers something personal about my child. When he
talks to me, he looks right at me – not at his paper work or
forms or does not talk on phone”
 FEW GENERAL
EXPECTATIONS
1. To have clinical core competence.
• Luxurious physical facilities can’t substitute for good care
• Good clinical methods
• Exude confidence
• Rational therapy – Dr. Batra’s – emotional & irrational
fears – treatment.
• Evidence based practices - apply the best available
evidence gained from the scientific method to medical
decision making
2. Honor the appointments. Appointment system should be
accurate but flexible.

3. Communicate well with them in day to day language.

Medical jargon should be avoided.

4. To listen to their problems patiently and give them enough

time. Master the art of listening

5. Show personal concern for the patient.

Body language ,greeting , a good first impression of a caring

physician, make it visible that we are with them in their
worst times too.

6. To explain everything about the illness and treatment.

7. Staff which shows care, concern, courtesy and empathy

8. Provide reasonably good physical facilities – approachable
location, good parking facilities

9.Impart health education: handouts, video examples

10. Proper documentation. – legible prescriptions – mediclaim

11.To provide hospital information brochure and to have

informative sign boards

12.To have transparency in financial matters

13. To use modern technology – diagnosis & therapy

14. To have easy flow between various services. - should not be

wasting time to avail of various services
 QUALITY HAS A NEW FACE
WITH CQI & TPM CONCEPT IN
HOSPITAL INDUSTRY
•   Providers
Increase In The Number Of Service

• Cost Of Service Delivery

• Emphasis On Cost-containment

• Changing Preferences Of Customers

• Changing Methods Of Service Delivery And Incidences Of Failure In

Implementation Of Tqm Are A Few Factors That Are Bringing A

Paradigm Shift In The Hospital Industry From Tqm To Cqi

(Continuous Quality Improvement) And Tpm (Total Productivity

Management),

• Hospitals , the world over are trying to deliver services according to

their patients expectations & thereby consolidate their brand equity.

 IMPLEMENTATION OF TQM IN
A HOSPITAL REQUIRES:
• Strategic leadership

• Financial resources

• Employee involvement and empowerment

• Streamlining of operational activities

• Commitment at the top-level management

• Changing organisational structure to reduce bottlenecks of line and staff conflict

• Developing a work culture for continuous learning and improvement so that it

is conducive to implementation of TQM

• Research conducted in a few Hospitals in US suggest that failure rate in

successful implementation of TQM is very high i.e. 60-67 per cent.

 FAILURES IN THE
IMPLEMENTATION OF
• TQM
Misconception CAN
- successful BE DUE
implementation of TQM -TO
can
substantially increase market share or profitability

• Difficulty in achieving structural specifications according to

standards laid down by accreditation bodies and standardization
organizations.

• Developing processes in assembly line pattern. Every patient

requires different service in different magnitude. In case of
individual units like radio-diagnosis, pathology, support services
like laundry and cafeteria processes can be standardized.
• Monitoring the outcome of service delivery because though
different patients suffer from same ailment even then magnitude,
degree and allied complications in each case vary.

• Due to stress on cost containment, employees perceive any change

brought by the hospital authorities as a threat to their existence
which makes implementation of new concepts an arduous task.

• Difficulty in removing barriers on consensus for decision making

and implementation.

• Failure to identify outputs that can be quantified in terms of

revenue as against the resources invested.
 TQM CAN BE
SUCCESSFULLY
IMPLEMENTED IN
• HOSPITALS IF:
Employees are made familiar with TQM concepts

• Hospital launches a data-driven decision making process based on

objective measurement criteria

• Group discussions are conducted to understand individual role in quality

improvement.

• Cross-functional team approach to problem solving is emphasised

• Internal communication plan is executed for better employee satisfaction,

motivation and co-operation.

• Physicians’ involvement is increased for improving the quality of clinical

care

• Resources are provided to implement TQM

 CQI
• ‘‘Continuous quality improvement is a sustained effort to streamline
operations with an objective of standardisation, cost containment and
customer satisfaction through input of available resources.”

• It is not a tool to generate revenues but it helps in increasing the patient

base by providing a brand identity in community which is being served by
hospital and thereby increasing the patient turnover.

• Develop quality circles .

• Ex: Generally, after consultation with a physician in OPD, a patient

generally is advised for diagnosis at pathology or imaging department or
both. A patient generally finds that waiting time for collection of sample or
delivery of reports is high or many of times the report is not ready.
• In such cases, it is observed that patient is dissatisfied and despite of high quality of

clinical care he rates services of hospitals as average. Benefits of implementing quality

circles are:

• A cross-functional approach to problem solving through quality circles provides an

opportunity to all members of the circle and there is less possibility of missing out on best

possible solution.

• In cross-functional approach, employees also feel satisfied and they get an opportunity to

express their idea and discuss pros and cons of their idea. In isolation, they may think that

they have a better solution to the problem and yet it can not be implemented. This

prevents employees from de-motivation, dissatisfaction and frustration.

• Cross-functional team approach does not require a heavy investment in terms of money.
ACCREDATIONS –NABH
& NABL
• National Accreditation Board for
Hospitals & Healthcare.

• National Accreditation Board for Testing

& Calibration Laboratories.
 Section 1
PATIENT CENTERED STANDARDS
Chapter Standards
Access, Assessment & 15
Continuity of care
Care of patients 18
Management of 13
Medications
Patients rights & 5
Education
Hospital Infection Control 9

SECTION 2
HEALTH CARE ORGANIZATION MANAGEMENT STANDARDS
Continous Quality 6
Improvement
Responsibilities of Mgmt 5
Facilities Mgmt & Safety 9
Human Resources Mgmt 13
SUCCESS CASE
STUDIES
 The Apollo Hospital in Gujarat, is a 400-bed multi-speciality
quaternary care hospital which has further strengthened the
healthcare infrastructure in the state, emerging as
benchmark in quality standards in healthcare delivery.

Patient Services Infrastructure

• MHC – A/v services • Cardiac
• Pharmacy • Neurology
• Front Office • Orthopedics
• Nursing stations • Cathlab
• OPD Waiting Area • MICU
• Sample collection • NICU
• Single/Sharing Room • Dialysis
• Presidential Suite • Recovery
• LDR sensors • Post Operative Wards
Diagnostics
• Radiology • LABS
• MRI • Biochemistry
• CTScan • Microbiology
• X-Ray • Hematology
• Mammography • Histopathology
• TMT
Emergency
• Echo
• EEG Physiotherapy
• Endoscopy Blood Bank
Audiometry
Ophthalmology
Dental
General OT
MRI is a non invasive method
of mapping the internal
structures of the body without
the use of ionizing radiation
using radio frequency signals
in magnetic field.
• Most "patient friendly" 1.5
Tesla MRI
• High patient comfort with a
choice of in-bore/channel
music
• Total Brain scan within 5
minutes
• Whole body screening within
2 minutes
Neuro Applications
• Functional MR
• Perfusion
• Diffusion (to detect early MRI & Console Room
infarcts)
• CSF flow

The only 1.5 Tesla MRI of Gujarat

The Hospital is well
supported by the
Department of Transfusion
Medicine providing blood,
blood Components and
performing laboratory
investigations on blood
group serology.

"Life is precious...............

Should be cared and

saved "

Be a blood donor and

save a life.

Blood Bank-Laminar Airflow & Centrifuge

The Only Private Blood Bank

The Microbiology
Laboratory at the Apollo
Hospitals, serves for
diagnosis of a vast variety
of Infectious Diseases of
Bacterial, Fungal, Viral,
Parasitic or Tubercular
nature, by using state-of-art
fully automated systems
many of which are installed
for the first time in Gujarat.
The reports are available in
hours compared to several
days by conventional
methods.

Microbiology Lab-Bacteria, Blood & TB Cultur

Biochemistry, Hematology
First in Gujarat, multi
parameter system for
immuno analyses and
nucleic probes &
detection. Entry of patient
data 7 analysis via
keyboard and can be
generated in form of
reports. Multiparametric
system for
immunoanalysis and
nucleocin probes
detection, management of
calibration, control and
patient data memory.

Biochemistry-Immuno Analyzer

Advanced Ultrasound Machines

It is different from the
rest, because with a
central nursing
station every cubicle
could be utilized as a
observation area
which reduces the
patient's mobility.

Emergency Nursing Station

24-hour Emergency and Trauma Care

 STANFORD UNIVERSITY
HOSPITAL
• In Jan 1993, they went in for major restructuring to reduce costs, & increase
quality in patient specifics.
• Used a process-management approach to coordinate their quality initiatives
around the goal of moving the organization toward “patient-centered care.”
• Significantly, although Stanford University Hospital has cut $50 million from
the budget over the past four years, their patient satisfaction ratings have
never been higher.
• With support from top management, a Patient-Centered Care Team (PCCT)
brought together managers from all areas of the hospital. Under the direction
of our consultants, Shaw Resources, the team decided to limit its work initially
to those processes that directly involve patient care, eliminating such behind-
the-scenes functions as data processing. We also narrowed our focus to
inpatient hospital care; outpatient processes will be tackled at a later date.
• The Patient-Centered Care Team then did something that we had never considered before—we

“walked through” a typical hospital experience, from admission to discharge, from the patient’s

point of view. We supplemented our biweekly meetings with outside reading assignments and

information gathered in videotaped focus groups with former patients

• The next step was to identify specific areas to address through separate “process management

teams” of the Patient-Centered Care Team. We chose to concentrate in this first phase on the

following processes and we launched one team per month until all seven were up and running:

• Admit Patient

• Provide Laboratory Support

• Provide Hotel Services

• Provide Patient/Family Support

• Manage Patient Care

• Provide Diagnostic & Treatment Support

• Management Complaints .

• Ex: The Manage Patient Care Team asked nurse managers to proactively collect patient complaints

based on defined quality measurements. “This was a difficult transition for many of us,”

Zimmerman says. “No one wants to hear a complaint and it took a great deal of effort to convince

units that there would be no shame attached to having a high number of complaints.” In a two-

month period, managers of ten general medical-surgical units gathered 178 documented complaints
 TATA MAIN HOSPITAL
• The need of every patient visiting the Hospital is ‘quick, effective health care
provided in an atmosphere of comfort- ie , shorter waiting time in OPD and for
investigations and quality time spent with the doctor.
• System improvement in OPD through removal of patient registration and
regularisation of appointment system led to an appreciable reduction in waiting
time.
• Communication classes for doctors – increased communications – satisfied
patients need for increased contact time.
• MOU between doctors & clinical staff to reduce lab results- pathology,
radiological – concept of internal customers. Reduced from 380 min to 90 min.
• Infection control committee – analyse & provide corrective measures – reduced
rate of infection.
• Brought in a QIP team in Cardiology department – to reduce OPD TIME to less
than 30 min – appointment rates – segregated time slots for diff. patients –
increased pump efficiency to 90% patients seen in 30 min.
 QUALITY MGMT INITIATIVES
IN HIMACHAL PRADESH
HOSPITALS
Quality circles have been introduced in 40 hospitals up to sub-divisional level in the State
•

• Seed money amounting to Rs. 92.00 lacs. Provided to Asptal Kalyan Samities for quality
improvement.

• State Quality standards for Health Institutions formulated and being implemented.

• PLANNING

• Skill up gradation/ training of staff

• Improvement of delivery mechanisms to remote/tribal areas

• Accountability to PRI’s of local health staff

• Road map for incentivising staff for posting in rural areas

 d ea d l in es
e et in g the
"M n o u g h ,
o t g o o d e
is n d li n es is
g t h e d ea
beat in
ec t a tio n ."
my exp -
i A m b a n i
Dhirubha
THANK YOU.

ICE CREAM MAKER – SUBIR

CHAUDHARY