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Total Quality Management in Practice: A Singapore Healthcare Study - Page 6

Strategic Planning

The majority of the hospitals have used mission statements as a guide for gaining commitment in patient care and training but not research. Improved patient care is positively related to:

a. establishing a mission statement in the strategic plan
b. physician involvement in managerial decision-making
c. forming healthcare networks with other providers
d. training of staff and doctors

However, research correlates with "managed care negatively". This implies that research activities would be reduced if a hospital develops or participates in "managed care" programmes. CEOs of hospitals are always concerned about the bottom-line. With a drop in income from managed care schemes as compared to fee for service, research activities in hospitals would be reduced, as research does not immediately bring in the money.

Quality Management

The findings indicate that customer satisfaction surveys (understanding the needs and expectations of patients) and benchmarking (understanding what others do, learning and implementing best practices) are positively related to having quality management as a strategic mission shared by every member of the hospital including healthcare professionals.

Benchmarking for quality improvement and total customer satisfaction is positively related to having a quality management environment dedicated to continuous improvements in all business and clinical functions, employ team for problem solving and continuously strive to meet and exceed customers' needs.

Human Resource Management

The majority of the hospitals have a climate of equal opportunity that nurtures and supports the fullest contributions of every member and this is positively related to building and maintaining an environment for employee participation and involvement, teamwork and leadership. This is very important for a multi-racial country like Singapore.

Emphasis on doctors and staff training and recognition/rewards scheme to encourage innovative efforts are positively related to having an organisation culture that builds and maintains an environment for employee participation and involvement, teamwork and leadership, management of change and using external resources for the training of doctors and staff.

Information and Innovation Management

The findings indicate that effective management information systems aimed at improving decision-making processes, quality of patient care, productivity and reduction in costs is positively related to:
a. Using information system/information technology and medical technology to enhance quality, to achieve and sustain competitive advantage.
b. Introducing quality circles to explore avenues for more comprehensive care for patients to improve productivity and increase customer satisfaction.

Policy Implications

This empirical study shows that it is important for top management to have a high level of understanding of what is required to develop a TQM culture in hospitals and TQM practices should include the following activities and processes:

i. establish a mission statement
ii. involve physicians in managerial decision-making
iii. form healthcare networks with other providers
iv. continuously train doctors and staff for service improvements and change management
v. conduct customer satisfaction surveys to understand the needs and expectations of customers, integrate the findings into the service design and delivery package for better quality care and continuous quality improvements
vi. adopt benchmarking for quality improvements and total customer satisfaction
vii. develop recognition/reward schemes to encourage innovative ideas
viii adopt effective MIS and new medical technologies to achieve and sustain competitive advantage
ix. introduce quality circles to explore avenues for more comprehensive patient care

However, the above policy implications, when compared to the principles of TQM established earlier, revealed the following similarities and new knowledge:

Similarities:

i. Customer-focused, continuous-improvement philosophy. Conduct customer satisfaction surveys to understand the needs and expectations of patients and integrate the findings from the survey into the service design and delivery process. Every member of the hospital including healthcare professionals should continuously strive to meet and exceed customers' expectations.

ii. Analytical knowledge and skills. Adopt benchmarking for quality improvements and total customer satisfaction.

iii. Interpersonal or "people" skills. Use internal and external resources to train medical and non-medical staff for service improvements and change management.
iv. Structure and organisation. Develop recognition/reward scheme to encourage innovative ideas from staff for improved productivity and increased customer satisfaction, builds and maintains an environment of teamwork and leadership.

New Knowledge:

i. Physician Involvement. Develop strategies to gain physician involvement in quality improvement and managerial decision-making.

ii. Information Management and Innovation. Adopt strategic MIS and new medical technologies and form strategic alliance with other healthcare providers.

Future Developments and Challenges

Over the past fifty years, the government has produced a universally acknowledged economic miracle in Singapore. The government has placed a high priority in investing our limited resources prudently in establishing a comprehensive healthcare delivery system. The authors believe that a TQM system for the healthcare industry could be established collaboratively among the government, healthcare providers, consumers and health professionals' societies. Therefore, the following future developments and challenges are recommended:

i. Government
a. Formulate national quality management policies, form a national co-ordinating organisation to oversee quality improvement, set up national assessment system to assess performance.
b. Revise hospital accreditation standards.
c. Healthcare manpower developments, educate and train healthcare professionals on quality concepts.
d. Form resource centre on best practices.
e. Encourage quality management research and development.
f. Funding for industrial and academic collaborations.
g. Intensify efforts to reduce market imperfection and increase buyer information.
h. Participate in international quality societies, symposium, etc.

ii. Hospitals
a. Provide quality management education for all staff including healthcare professionals.
b. Adopt an organisation-wide definition of quality. Develop standard procedures or manuals for all staff including healthcare professionals.
c. Develop quality assessment tools to evaluate existing quality management activities and processes.
d. Conduct quality improvement programme.
e. Implement inter- or intra-hospital quality improvement projects

Conclusion

This paper essentially reports the findings of a survey on the TQM practices of Singapore hospitals. Our results, discussed above, indicate that they have reached a certain state of development. However, they should evaluate their existing TQM activities and processes and the result could form the basis for the policy-making process. Furthermore, TQM activities should be gradually integrated into the healthcare delivery system. However, the journey towards total quality healthcare is not easy. Future research is required to help practising managers answer the following questions as they pursue their total quality journey.

i. How should hospitals evaluate their existing TQM activities and
processes?
ii. What are the expectations of customers?
iii. Could their TQM activities and processes meet the expectations of customers?
iv. How should hospitals implement the TQM activities and processes to achieve total quality healthcare?

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