Strategies in Total
Quality Management
Dr. Resty L. Picardo
CONTENT
01 Internal Process S
02 Cost Reduction
03 Environmental Effects
04 Regulatory Compliance
01
Internal Process
What is an internal process?
is a type of business process that
organizations perform without the
influence or involvement of external
business partners.
is an aspect of the balanced scorecard
method, which is a performance metric
an organization can use to identify areas
that may need improvement. After
determining what to improve, the
hospital can take steps to adjust these
areas, such as by improving
BENEFITS OF USING INTERNAL
• enhance efficiency by eliminating areas of
PROCESS
congestion during the servicing process.
• allows the company to serve its
demographics more effectively and improve
the overall customer experience.
Other benefits :
• Ensuring consistent quality in products and
services job responsibilities
• Clarifying
• Providing direction for employees by setting
objectives to measure goals and outcomes
• Defining accountability to help employees succeed
How to improve
internal process
Explain your
making improvements,
Conduct an Audit Set an purpose
share with the team why
One can examine how the After reviewing operations,
there is an interest in
Objective
identify what aspects would
business currently delivers enhancing the business
services to customers, then be refined. One can
processes. Explain how the
create an outline that determine which areas may
changes may benefit them
includes each team need improvement by
and the company. Enhanced
member's responsibilities. An thinking about what types of
productivity can help the
audit can also include looking tasks challenge the
hospital save time and
at how the hospital solves employees and what parts of
capital. One can also provide
problems and manages risks, the service process may
the team with tips about how
such as emergency experience congestion.
to adjust to the changes
situations. Addressing the unique issues
successfully and how to solve
the hospital encounters can
problems if they experience
help save time and money
any challenges during the
How to improve
internal process
Revaluate your
Automate processes internal process
Locate areas in the hospital regularly
Review internal process
that may benefit from regularly to find additional
automation. While there may areas that may need
be an initial fee for improvement. This can help
automating procedures, ensure the hospital continues
these changes often save making appropriate
hospitals time and money in adjustments based on
the long term. current data. Consider
conducting an audit at least
once a year to reassess and
improve internal process
consistently.
4 types of internal process objectives
Operation management processes
are the daily actions a hospital takes to create its services
and deliver them to customers.
Objectives in this area of the internal process may include the
following:
• Maximizing your yield
• Improving resource productivity
• Increasing the rate of processing your materials
• Minimizing marketplace risks
Customer management
processes
refers to the steps taken to develop a relationship with the target
customers.
4 types of internal process objectives
Innovation processes
are the steps an organization takes to reach new markets
by creating alternative products, services and processes.
This can help stay competitive in the marketplace and
appeal to new types of customers. During the innovation
processes, companies may identify opportunities and find
ways to apply innovative technologies. After selecting new
projects to work on, organizations may plan how to design
them, set goals for sales and introduce them to the
marketplace.
• Creating a unique service
• Expanding into a new market by offering a diverse set of
services
Regulatory and social
processes
are the business activities that help communities accept an
organization. This may include actions, such as complying
with industry standards and improving employee safety in
the workplace.
• Supporting the health and safety of all employees
• Earning a best-in-class governance title
• Maintaining active involvement in the local community
02
Quality
Improvement Plan
(QIP)
Quality Improvement Plan
are essential tools that enable organizations to
focus on improving patient-centered care. They
provide a structured format and a common
language that fosters dialogue and supports
continuous quality improvement processes. By
formalizing plans, QIPs drive change and facilitate a
culture of continuous improvement.
uses a deliberate and defined improvement
process, such as plan-do-study-act, focused on
activities that are responsive to organizational
needs and improving population health. It refers to
a continuous and ongoing effort to achieve
measureable improvements in areas such as
efficiency or effectiveness.
QIPs are to be developed by the organization. The Board, senior management, clinicians, other
staff, and patients/ clients/residents should be engaged in its development.
Step-by-Step Guide on Developing a
Quality Improvement Plan
1. Use organizational-level data to identify current performance
and/or baseline for the priority indicators. (If no baseline exists,
note this in your QIP, and begin gathering the data needed).
2. Organizations are expected to review the priority indicators for
their sector and determine which are relevant for their
organization. To support this process, the organization should
review its current performance against provincial
benchmarks/theoretical best for all priority indicators. If the
organization elects not to include a priority indicator in the QIP (for
example, because performance already meets or exceeds the
benchmark/ theoretical best), then this should be documented in
the comments section of the QIP Workplan. Any additional
indicators can also be included in your QIP as relevant to the
organization’s quality improvement goals. HQO provides additional
resources to support selection of indicators for your QIP
Step-by-Step Guide on Developing a
Quality Improvement Plan
3. Use the guidance provided to create a plan to address each of
the system level priorities you identified for improvement. A plan
includes setting a target, identifying change ideas to be tested,
methods and process measures, as per the QIP workplan.
4. Ensure one completes the Narrative to use to communicate
these priorities to the communities and staff. Also complete the
Progress Report (for those organizations that have more than one
year of information to report on).
5. Sign-off: Once the QIP has been approved by the Board, the
Quality Committee (if applicable) and key senior leadership, those
involved need to “sign-off” on the QIP. This is an important
component to help demonstrate the shared accountabilities and
responsibilities for the QIP at the governance, clinical, and
administrative levels
Characteristics of a Good
Quality Improvement (QI)
I. Purpose and Scope Plan
This section describes the scope, purpose, and the vision
for the future state of quality in the organization. This
section could also include definitions of key quality terms,
and goals for the overall QI program or QI council
These questions may help guide the organization in
developing the purpose.
1. What is the mission/vision/goals of quality within the
organization?
2. What is the current quality culture within the
organization and where do you want it to be?
3. Why is there a need for QI within the organization?
4. What is the scale of QI in the organization?
Characteristics of a Good
Quality Improvement (QI)
II. Plan
Structure of QI program, including
resources, roles, and responsibilities
This section describes how the health
department will provide the oversight and
direction for QI activities.
Additional information to
include:and rotation of the QI oversight group – include the
• Membership
members’ staff position
• An explanation of the roles and responsibilities of specific
leaders and staff
• Staffing and administrative support
• Budget and resource allocation for conducting QI activities such
as staff designated to work on QI activities and data analysis
resources
• Link to the agency’s performance management system (if in
Items that could beplace)
included include QI Council Charter, QI organizational chart,
Characteristics of a Good
Quality Improvement (QI)
Plan
III. Process for identification of QI efforts
This section should describe the process that
will be used to identify and prioritize quality
improvement activities that will be done in the
coming year. This section could also include
information on how the improvement projects
connect with the health department’s strategic
plan, organizational vision/mission or
organizational performance measures. This
section may include a template for QI project
requests
Characteristics of a Good
Quality Improvement (QI)
IV. Goals, objectives and measures Plan
This section should include the overall goals, objectives
and time-framed measures for the organization that will
be tracked during the upcoming year. These should focus
on organizational goals, not specific projects and could be
based on the QI maturity tool assessment results.
The following should be included:
• Define the performance measures to be achieved.
• For each objective, list the person(s) responsible (an
individual or team) and time frame associated with targets
• Identify the activities or projects associated with each
objective and describe the prioritization process used
Characteristics of a Good
Quality Improvement (QI)
V. Plan
Monitoring progress and results of goals,
objectives, and measures
This section describes the scope, purpose, and the vision
for the future state of quality in the organization. This
section could also include definitions of key quality terms,
and goals for the overall QI program or QI council
These questions may help guide the organization in
developing the purpose.
1. What is the mission/vision/goals of quality within the
organization?
2. What is the current quality culture within the
organization and where do you want it to be?
3. Why is there a need for QI within the organization?
4. What is the scale of QI in the organization?
Characteristics of a Good
Quality Improvement (QI)
VI. Training Plan Plan
Include in this section the types of quality improvement
training available and conducted within the organization,
such as:
• New employee orientation presentation materials
• Introductory online course for all staff
• Advanced training for lead QI staff
• Continuing staff training on QI
• Other training as needed—e.g., position-specific QI
training (MCH, Epidemiology, etc.)
Characteristics of a Good
Quality Improvement (QI)
VII. Communication Plan Plan
This section should describe the communication plan for
any/all quality improvement efforts conducted in the
organization. Within the communication plan, the
following can be included: descriptions of the timing, the
mechanisms being used, person(s) responsible, frequency,
and targeted audiences for all communication efforts. The
Communication plan can include how successes will be
Somepromoted
examplesand
maystaff efforts
include therecognized.
following:.
• Quality Improvement newsletter
• Story boards displayed publicly
• Recognition wall at agency
• Board of Health meeting updates
• Staff updates during meetings or through email
• How the QI Oversight Team will communicate with staff (e.g.,
sharing of meeting agendas and minutes)
Characteristics of a Good
Quality Improvement (QI)
Plan
VIII. Evaluation of QI plan and activities
This section should describe the process used to assess
the effectiveness of the quality improvement plan and
activities. This
could include:
• Review of the process and the progress toward
achieving goals and objectives for the QI plan and
QI activities
• Efficiencies and effectiveness obtained and lessons
learned
• Customer/stakeholder satisfaction with services and
programs
• Description of how reports on progress were used to
revise and update the quality improvement plan
Sample Template
Quality Improvement (QI)
Plan
Sample Template
Quality Improvement (QI)
Plan
03
The Role of
Organizational
Leadership
PDSA Cycle
The PDSA Cycle (Plan-Do-Study-Act) is a systematic
process for gaining valuable learning and knowledge for
the continual improvement of a product, process, or
service.
Also known as the Deming Wheel, or Deming Cycle, this
integrated learning - improvement model was first
introduced to Dr. Deming by his mentor, Walter Shewhart
of the famous Bell Laboratories in New York.
The cycle begins with the PLAN step. This involves
identifying a goal or purpose, formulating a theory, defining
success metrics and putting a plan into action.
These activities are followed by the DO step, in which the components of the plan are
implemented, such as making a product. Next comes the STUDY step, where outcomes
are monitored to test the validity of the plan for signs of progress and success, or
problems and areas for improvement. The ACT step closes the cycle, integrating the
learning generated by the entire process, which can be used to adjust the goal, change
methods, reformulate a theory altogether, or broaden the learning – improvement cycle
from a small-scale experiment to a larger implementation Plan. These four steps can be
repeated over and over as part of a never-ending cycle of continual learning and
Why is Leadership in Quality
Improvement
Important?
Improvement in care is faster when leaders are engaged
and where leadership for improvement is explicitly
implemented. Leaders are critical for owning and
expanding the QI approach and providing the needed
energy for implementation and scale up.
Though we are not all born leaders, everyone has the potential
to lead improvement. Leaders must be empowered to improve
care, to induce others to become leaders, to see the potential of
something, honor it, and support others in improving care.
Key leadership clusters and attributes
Key leadership clusters and attributes
Key leadership clusters and attributes
Epistemology
The scientific method (Shewhart and Deming
1939) is to be used:
In this sense, specification, production, and
inspection correspond respectively to making a
hypothesis, carrying out an experiment, and
testing the hypothesis. These three steps
constitute a dynamic scientific process of
acquiring knowledge.
In the context of engineering, Platonic
epistemology starts from reason (and in
extended sense, from existing knowledge) and
deduces prescriptions to be pushed towards
the world. Instead, Aristotelian epistemology
emphasizes observations made on the world
and induction of new knowledge based on
them.
Role of Leadership in Quality Management
Leadership is responsible for setting the vision
and direction for the organization. This includes
01 defining the organization's goals and objectives
related to quality management. Effective leaders
communicate this vision to their teams and
ensure that everyone is aligned and working
towards the same goals.
Leadership is also responsible for creating a culture of quality within the
organization. This means promoting the importance of quality and making it a
core value of the organization. Effective leaders lead by example and
02 demonstrate their commitment to quality in everything they do. This sets the
tone for the rest of the organization and encourages everyone to prioritize
quality in their work.
Leadership is responsible for providing the necessary resources to
support quality management efforts. This includes providing funding for
quality improvement initiatives, as well as providing the necessary
03 tools and equipment to support quality control and quality assurance
processes. Effective leaders understand the importance of investing in
quality management and are willing to allocate the necessary resources
Role of Leadership in Quality Management
Continuous improvement is a key component of
quality management. It involves identifying areas
04 for improvement and making changes to improve
the quality of products or services. Leadership
plays a critical role in encouraging and promoting
continuous improvement. Effective leaders
encourage their teams to take a proactive
approach to identifying areas for improvement
and implementing changes to address them.
Leadership is also responsible for developing and supporting their employees.
This includes providing training and development opportunities to help
05 employees improve their skills and knowledge related to quality management.
Effective leaders also provide support and guidance to their teams to help
them achieve their goals and overcome any challenges they may encounter.
effective leader in quality
management
In order to be an effective leader in quality management, there are
several key skills and qualities that are important to have. These
include:
Strong communication skills to effectively communicate
the vision and goals related to quality management
The ability to inspire and motivate employees to
prioritize quality in their work Strong problem-
solving and decision-making skills to identify areas
for improvement and implement changes to
address them
A commitment to continuous improvement and a
willingness to take risks to drive innovation
The ability to build and maintain strong relationships
with employees, customers, and stakeholders
Conclusion
In conclusion, leadership plays a critical
role in quality management. Effective
leaders are responsible for setting the
vision, creating a culture of quality,
providing resources, encouraging
continuous improvement, and developing
and supporting their employees. By
prioritizing quality management and
investing in strong leadership,
organizations can improve the quality of
their products or services and achieve
04
Quality
Improvement
Programs (QI
Programs)
Quality Improvement programs come in two primary
forms:
Organization-wide, Ongoing Programs
These long-term initiatives permeate the entire organization,
focusing on continuous improvement in areas like patient safety,
experience, and operational efficiency.
Process-Specific Projects
These targeted efforts address specific issues within a defined
timeframe, acting as rapid response teams to tackle immediate
challenges.
Why Are Quality Improvement (QI) Programs
Important for Healthcare?
Improved Patient Outcomes: QI initiatives directly translate to
01 better health outcomes for patients, including reduced mortality rates,
fewer complications, and shorter hospital stays.
Enhanced Efficiency and Productivity: Streamlined processes and
02 optimized workflows lead to increased efficiency, allowing healthcare
providers to deliver care more effectively.
03 Reduced Costs and Waste: Identifying and eliminating inefficiencies in care delivery
helps reduce costs and minimize waste, making healthcare more sustainable.
Increased Patient Satisfaction: Patients who receive high-quality care are more likely to be
04 satisfied with their experience, leading to improved loyalty and positive word-of-mouth.
Regulatory Compliance and Accreditation: QI programs help healthcare
05 organizations meet regulatory requirements and achieve accreditation, demonstrating a
commitment to excellence.
How Do You Evaluate Healthcare Quality?
Clinical Outcomes: Assessing patient health outcomes like mortality
01 rates, readmission rates, and complications.
Patient Experience: Gathering feedback from patients about their
02 satisfaction with care, communication with providers, and overall
experience.
03 Safety: Monitoring adverse events, medication errors, and hospital-acquired infections.
04 Efficiency: Tracking resource utilization, wait times, and the timeliness of care delivery.
05 Equity: Examining disparities in care access and outcomes among different patient
populations.
Tools and methodologies: Patient surveys, clinical audits, and data analysis. Key Performance Indicators (KPIs) are established to
track progress and identify areas where improvement is needed.
How Do You Achieve Quality Improvement?
Identifying and Prioritizing Areas for Improvement: Analyzing
01 data and gathering feedback to pinpoint areas where quality can be
enhanced.
Developing Improvement Plans: Creating detailed plans outlining
02 the specific actions and interventions required to address identified
issues.
03 Implementing Changes: Putting the improvement plans into action and monitoring
their progress.
04 Evaluating Results: Collecting data and analyzing outcomes to determine the effectiveness of
the changes.
05 Sustaining Improvement: Embedding successful changes into routine practice and
continuously monitoring for further improvement opportunities.
Stakeholders Who Have a Role in Quality
Improvement
Patients: Their feedback and experiences are invaluable in
identifying areas for improvement and measuring the success
of QI initiatives.
Healthcare Providers: Physicians, nurses, therapists, and other
clinicians play a crucial role in implementing QI strategies and
providing direct patient care.
Administrators and Leadership: They set the vision for QI, allocate resources,
and ensure alignment with organizational goals.
Quality Improvement Professionals: These experts lead QI initiatives, collect and
analyze data, and facilitate change management.
Community Members and Advocacy Groups: They provide valuable
perspectives and advocate for patient-centered care.
Regulatory and Accreditation Aspects of
Quality Improvement
Quality improvement is deeply intertwined with regulatory
requirements and accreditation standards. Organizations
like The Joint Commission, the National Committee for
Quality Assurance (NCQA), and the Centers for Medicare &
Medicaid Services (CMS) set rigorous standards and
conduct regular evaluations to ensure compliance.
Quality Improvement programs help healthcare
organizations meet these standards and
maintain compliance, ensuring that they deliver
safe, effective, and equitable care.
Challenges and Barriers to Quality
Improvement
Resistance to Change: Healthcare professionals
01 may be hesitant to adopt new practices or
processes.
Lack of Resources: Limited funding and staff can
02 hinder QI initiatives.
Data Limitations: Incomplete or inaccurate data can
03 make it difficult to identify problems and track progress.
Time Constraints: Healthcare professionals often face
04 demanding schedules, making it challenging to dedicate
time to QI activities.
Technology in Quality
Improvement
Technology plays a key role in modern
healthcare quality improvement.
Electronic Health Records (EHRs) provide
a wealth of patient data that can be
analyzed to identify trends and areas for
improvement. Telemedicine and remote
monitoring tools enable healthcare
providers to reach patients in their homes,
improving access to care and reducing
hospitalizations.
Artificial intelligence (AI) and machine
learning algorithms can also analyze vast
amounts of data to identify patterns and
predict outcomes, informing clinical
decision-making and driving personalized
Quality Improvement Frameworks and Models
Plan-Do-Study-Act (PDSA): This iterative model involves
planning a change, implementing it on a small scale, studying
the results, and acting based on what was learned.
Lean: This methodology focuses on eliminating waste and
streamlining processes to improve efficiency and value.
Six Sigma: This data-driven approach aims to reduce variation and defects in
processes, leading to improved quality.
The Baldrige Excellence Framework: This comprehensive framework provides a
systematic approach to organizational performance excellence, including quality
improvement.
What is the Healthcare
Quality Improvement
Act?
The Healthcare Quality Improvement Act
(HCQIA) is a U.S. federal law enacted in
1986 to encourage peer review and
improve the quality of medical care. It
provides legal protection to healthcare
professionals and institutions participating
in peer review activities, promoting
accountability and excellence in
healthcare.
The HCQIA encourages peer reviews by
protecting reviewers from legal liability,
establishes standards for professional
conduct and quality assurance, promotes
accountability through regular peer
assessments, and aims to improve patient
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