The Pursuit of Total Quality is not a Sprint but a Marathon

Professor Bob Haigh and Professor D. S. Morris

Far too often in both public and private sector organisations one is faced with the problem of not merely the determination of what constitutes “Quality” within organisations, but also with the fact that Senior Management invariably indulges in the paradox of preaching the virtues of Total Quality Management and quality services while simultaneously demonstrating what could be construed as either an unwillingness or inability to support their words with appropriate deeds.

Any organisation or indeed any part of an organisation which sets setting out on the path leading to TQM, has to face up to the fact that they must fulfil certain basic criteria to embark on that journey. They need to determine what is quality; what are the agreed principles of TQM; how to differentiate between an ordinary and quality management system, coupled with its key elements.

Fortunately, help is at hand; if the organisation is dedicated to quality as an integral part of its culture and daily operations, then there are countless check lists available by which appropriate measurements can be undertaken.
Not least among these lists are various views of what constitute the basic principles of TQM. Although there are differences of opinion, the main views could be collectivised in an insistence that any TQM approach is management-led; the scope of TQM should be organisation-wide; everyone should be responsible and accountable for the quality of their operations; the mainspring of TQM philosophy should be characterised by the pursuit of prevention not detection; the basic measurement standard should be right first time; the actual cost of quality should be its primary control; and the overarching theme should be one of continuous improvement.

From the foregoing it can quickly be determined that a number of “key elements” can be identified with relation to TQM. Any Public Sector Manager can feel secure in the utilisation of the under-mentioned twelve points as a check list which must be addressed if the intention is to attempt to implement TQM within their organisation.

KEY ELEMENTS

1. Quality Awareness
2. Management Leadership
3. Organising for Quality Improvement
4. Creating a Participative Environment
5. Training for Quality Improvement
6. Involvement of Every Function at all Levels
7. Customer and Supplier (internal and external) Involvement
8. Problem Prevention and Solving
9. Statistical Process Control
10. Measurement of Quality Performance
11. Recognition for Achievement
12. Continuous Improvement

All developed countries have in place some more or less comprehensive system for ensuring that their citizens have access to health care. The UK has a health care system under which the funding of the provision of health care and the management of that provision comes from the state.

NHS expenditure, therefore, constitutes about 1/8 of all public spending in the UK. The administration of this vast organisation is a decentralised one wherein the Department of Health does not administer the NHS but allocates money to health authorities which have the prime operational responsibility for the Service. The funds allocated come from the annual public expenditure round in which the spending departments of the state agree with the Treasury how much is to be assigned to particular public programmes.

The essence of this is, therefore, a global budget from which a range of services has to be provided via a decentralised system.

To appreciate these issues it is necessary to understand some of the specific details of NHS expenditure:

1. and the most important, is that over seventy percent (70%) of spending is on salaries and wages. This means that large cash increases in expenditure may produce only small improvements in service, since most of the money may simply add to the incomes of service providers.
   
2. productivity improvements in health are usually more difficult to achieve than in manufacturing since there is less scope in services than in manufacturing for substituting machinery for labour. Consequently, if service pay keeps pace with increases in the manufacturing sector, productivity, and hence real increases in the health care delivered will lag behind.
   
3. the system of global budgeting for DHAs and individual hospitals means that efficiency gains that are secured will often add to costs, not lead to savings. If more patients are treated in a ward (an efficiency gain) the cost of peripherals (drugs etc) will also increase. Since the extra patients do not bring extra income with them, the relatively more efficient hospitals find that their costs are actually increased and not decreased. This scenario was called the “efficiency trap” by the House of Commons Select Committee on the Social Services

The nature of the changes facing, and indeed impacting upon, the NHS at this moment in time can be said to include the following:

• Demand for services
• Delivery of services
• Material surpluses and shortages and their location
• Competition from rival service producers
• Technology and its applicability to health
• Management information as an aid to decision-making
• Values and expectations of providers and clients
• Nature and magnitude of government involvement
• Union strategies and priorities
• Funding patterns

The following case study is intended to demonstrate how the journey towards becoming a TQM organisation can begin.

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