The case for using industrial quality management science in health care organizations

Article Abstract:

Traditional approaches to the quality of medical care are based on delivering care designed to maximize patient welfare coupled with an expectation of some level of medical standards. This approach expects that not all treatments will go well and that there will be some level of acceptable difficulty (morbidity) and death. This statement of health care is usually assessed by measuring three aspects: measuring performance, determining whether the measured performance conforms to medical standards and determining means of reaching standards. This method has several major problems. The definition of quality of care does not agree with modern medical practice, in which comparison to a standard implies that the goal is absolute and assumes that, in some cases, the clinical result will be poor. This method allows little information to be collected when a standard is met and also allows the practice to be governed by a standard which may be set unrealistically low or high. Most quality assessment is based on measuring the physician alone, when in fact the treatment of patients involves several different professionals, nonprofessionals and services. A new way of assessing medical quality is to employ modern-quality science, which is used in many non-health care related industries. This statistical technique has often led to dramatic improvements in the quality of products and services and to increased profitability. A modest modification of the definition of quality used by nonmedical environments can provide a suitable medical definition of quality; "effort by all members of an organization to meet the needs and expectations of the customer (patient)." Modern industrial thinking recognizes the existence of variation in all aspects of the provision of service, including medical care. Measuring and assessing service is important, particularly when multiple sources of variation are present. Experts also stress that the procedures or processes should be the object of improvement, not the individuals. In medicine, this would include all transactions between physicians and patients. Analyzing all medical processes to remove rework and waste could build medical quality and lead to significant reductions in cost. The use of quality-assurance programs can be directly applied to health-care organizations with improved quality of patient care and good results financially.

Medical economics, Economic aspects

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Quality in health care

Article Abstract:

There is a wide gap between possible and actual quality in medical care. Several studies have shown that patients can suffer side effects and complications from the drugs and procedures they receive during their hospitalization. The gap and wide variation in medical practice has led to the development of clinical practice guidelines. There has been little research on educating physicians, or helping them to implement guidelines in day-to-day practice. Total quality management (TQM), sometimes called continuous quality improvement, is a method of continuous assessment and improvement developed in management fields outside medicine. As applied to medicine, it emphasizes understanding the patient's objectives and the results of care from the patient's viewpoint.

Innovations, Total quality management

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The future of quality measurement and management in a transforming health care system

Article Abstract:

Information technology may have a significant impact on the measurement of health care quality. The Internet, the computerized medical record and teleconferencing are three information technologies that may transform the evaluation of medical care. The computerized medical record will allow medical care to be monitored at a detailed level that was not possible before. On the other hand, the wide array of health information on the Internet allows patients to manage much of their care on their own, particularly if they have a chronic disease. Assessing health outcomes could be a challenge in these patients.

Analysis, Usage, Internet, Information technology, Outcome and process assessment (Health Care), Outcome and process assessment (Medical care)

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