Assessing the environment of continuous quality improvement in the hospital

Is accreditation help to improve the quality in healthcare?

By

ACKNOWLEDGEMENT

This research became possible only because of support from my research supervisor and my loved ones. Hence, I would like to say thanks for their support.

DECLARATION

This research is my own work and does not represent the ideas of the university. This project belongs to me and only me.

TABLE OF CONTENTS

ACKNOWLEDGEMENTII

DECLARATIONIII

CHAPTER 1: INTRODUCTION1

The Hospital organization in Transition1

Background of the Problem5

Statement of the Problem6

Research aims and objectives7

Research question8

CHAPTER 2: LITERATURE REVIEW9

CQI/TQM - Philosophy and Key Components9

Emergence of CQI9

Deming's 14 Point Program10

Essential Components12

Basic Concepts in CQI/TQM12

Implementation Issues in CQI in Health Care16

The Decision to Adopt CQI16

Essential Components for CQI implementation Success Transforming the Organization17

Commitment18

Planning18

Teamwork19

Communication19

Education20

Patience: The importance of patience cannot be overemphasized.20

The Need to Define One's "Customers"21

Management support22

Barriers to CQI implementation23

Problems associated with organizational culture:24

Overcoming engrained philosophies and mind-sets24

Resistance to role change24

Organizational goals not clearly communicated25

Lack of perceived management presence and support25

Viewing CQI as a quick fix26

Role changes for management26

Organizational commitment26

Quality assurance/quality control difficulties27

Quality assurance at the end of the process27

Minimum standards of care27

Performing QA tasks for the wrong reasons27

Problems with the quality improvement team28

Lack of interdisciplinary teams28

Lack of creative benchmarking29

Perceived political barriers30

Some Applications of CQI and Their Effects31

Continued Interest in CQI34

CHAPTER 3: METHODOLOGY36

Research design36

Pros and cons37

CHAPTER 4: DISCUSSION39

Emergence of CQI in Health care39

The Role of CQI in the Health Care Field41

Accreditation43

Potential Benefits of Public Health Accreditation45

Limitations of Public Health Accreditation49

CHAPTER 5: CONCLUSION52

REFERENCES55

CHAPTER 1: INTRODUCTION

The Hospital organization in Transition

The health care industry has become one of the largest businesses in the nation. Whereas in the early 1980's the cost of health care was 10 percent of the gross national product (GNP), in 1993, it absorbed 14.6 percent of the GNP. The figure is expected to reach $1.6 trillion or 16.4 percent of the GNP by the year 2013 (Mandhari 2000).

In the early 1980's, the federal government became very concerned about the rising cost of health care and enacted the Diagnostic-Related Grouping reimbursement legislation which essentially reimbursed hospitals on the basis of diagnosis rather than on the basis of costs. In this scenario, a hospital would lose dollars if it spent more than the reimbursement schedule and could gain dollars if it spent less. In the past physicians and hospitals only, if at all, justified their clinical practices to one another. Today, they are being asked to explain their actions to managed care systems, government agencies, utilization review departments and payers.

At the same time that these changes were being seen in health care, American industry began to assimilate the Total Quality Management process which was so successful in Japan. Total Quality Management is defined as a management style which focuses on the systematic and continuous improvement of processes which achieve mutually agreed upon customer requirements. It can also be defined as a structured system for creating organizational wide participation in planning and implementing continuous improvement not only to meet customer needs, but to exceed their expectations. The focus is on the improvement of the processes rather ...