The Nnrse Execdve Total
Quality
D
Management-A
URING the last half century the focus of the health care industry in this country has moved from research to access to health care, to cost of health care, and, in recent times, to quality of health care. Indeed, the 1990s can be identified as the decade of quality, value, and customer expectations. Although the health care industry followed corporate America in this movement, during this decade we can count on the nationwide integration of a relatively new system called total quality management (TQM) across health care, health education, and related organizations. TQM is an integrated and innovative system of managerial and organizational activities designed to clearly define and streamline production processes, remove waste and unpredictability, achieve previously unprecedented levels of performance with fewer resources, and meet customer expectations at the highest level. The theory, philosophy, and methods of TQM are attributable to W. Edwards Deming, Joseph Juran, Armand Filgerbaum, and Kaoru Ishikawa. Moreover, the system has been credited by many Japanese and US corporations as being responsible for their success. Quality is nothing new to nursing. It has always been a part of our philosophy, standards, and record of care. In fact, during the past decade, in health care delivery organizations, we have been involved in quality assurance programs as dictated by regulatory agencies. However, it is interesting to note that as we move into the 199Os, the Joint Commission on the Accreditation of Health Care Organizations has diminished its reference to quality assurance and is increasing emphasis on continuous quality improvement. This principle is the foundation of TQM. This means that attention will now be directed to improving performance proactively, rather than dealing reactively with system failures. Clearly, one cannot argue with the premise of TQM. It is good for everyone because everyone is a customer. Since this editorial centers on health care organizations, I will elaborate on the customer. The customer in TQM includes patients, families, medical staff, referring physicians, government, accrediting bodies, employers, students, and (for emphasis) nurses. As good as it sounds, TQM cannot hap-
KATHLEEN
G. ANDREOLI, DSN, FAAN
Vice President, Nursing Affairs,
and Dean
The College of Nursing Rush Clniz~ersity 630 S Hemrtage
Ata
Suite 204 Chicago, IL 60612
Copyright 0 1992 by W.B. Saunders Company
8755-7223/92/0802-0004$03.00/O
72
New
Culture
pen overnight. The new system requires a total paradigm shift in health care management, meaning that the organization must commit to total participatory involvement, collective responsibility, continuous improvement, and flexible objectives and plans. Success requires that the movement begin with organizational leadership. Officials must invest time, capital, and technical expertise in the movement. Moreover, they must support the change that the organization must undergo. This change is facilitated by a corporatewide educational program that teaches sensitivity to customer expectations, measurement systems, communication, planning, and compliance with standards that have been mutually agreed on. It is reassuring to note that across the country nursing is becoming vested in TQM and is actively involved in the process, ie, identifying the indicators of care that describe the quality outcomes expected; establishing levels or thresholds for evaluation, collecting, and evaluating data; taking actions to improve care; assessing effectiveness of these actions; and disseminating the results as necessary. The vehicle for this process is the TQM project. The TQM project is an opportunity for staff nurses to conduct a study to improve care and to share their findings and recommendations with nurses and related health care workers. Note that continuous improvement projects can occur at any level of the organizational hierarchy. Employees trained in TQM concepts are empowered to make improvements in their work; moreover, they are expected to do so. The organization believes that nurses most closely involved in care have the best ideas on how to make imand in doing so will experience better effiprovements, ciency, greater effectiveness, lower cost, and the gratitude of more satisfied patients. I am fortunate to be a part of a health care corporation that has undergone the TQM movement during the past 3 years. Recognizing that it takes at least 3 to 5 years to attain significant organizational transformation, we are encouraged by the early changes and committed to the project. TQM projects offer a rich environment for the unification of nursing service and education. Faculty can assist staff on such projects. Moreover, such projects can serve as a foundation for a more expansive research project by faculty and staff at a later time. The model is an excellent teaching opportunity, and student nurses can become involved in the process. Never before have staff nurses been so empowered to create change in health care and the rewards, especially the pleased customers, are many. American health care and nursing have much to learn from the theory of continuous improvement. Viewing the progressive movement thus far, it seems that we are establishing an even better quality of hr lith care than previously. The next generation will be grateful.
Journal of Professional Nursing, Vol 8, No 2 (March-April),
1992:
p 72
Quality
D
Management-A
URING the last half century the focus of the health care industry in this country has moved from research to access to health care, to cost of health care, and, in recent times, to quality of health care. Indeed, the 1990s can be identified as the decade of quality, value, and customer expectations. Although the health care industry followed corporate America in this movement, during this decade we can count on the nationwide integration of a relatively new system called total quality management (TQM) across health care, health education, and related organizations. TQM is an integrated and innovative system of managerial and organizational activities designed to clearly define and streamline production processes, remove waste and unpredictability, achieve previously unprecedented levels of performance with fewer resources, and meet customer expectations at the highest level. The theory, philosophy, and methods of TQM are attributable to W. Edwards Deming, Joseph Juran, Armand Filgerbaum, and Kaoru Ishikawa. Moreover, the system has been credited by many Japanese and US corporations as being responsible for their success. Quality is nothing new to nursing. It has always been a part of our philosophy, standards, and record of care. In fact, during the past decade, in health care delivery organizations, we have been involved in quality assurance programs as dictated by regulatory agencies. However, it is interesting to note that as we move into the 199Os, the Joint Commission on the Accreditation of Health Care Organizations has diminished its reference to quality assurance and is increasing emphasis on continuous quality improvement. This principle is the foundation of TQM. This means that attention will now be directed to improving performance proactively, rather than dealing reactively with system failures. Clearly, one cannot argue with the premise of TQM. It is good for everyone because everyone is a customer. Since this editorial centers on health care organizations, I will elaborate on the customer. The customer in TQM includes patients, families, medical staff, referring physicians, government, accrediting bodies, employers, students, and (for emphasis) nurses. As good as it sounds, TQM cannot hap-
KATHLEEN
G. ANDREOLI, DSN, FAAN
Vice President, Nursing Affairs,
and Dean
The College of Nursing Rush Clniz~ersity 630 S Hemrtage
Ata
Suite 204 Chicago, IL 60612
Copyright 0 1992 by W.B. Saunders Company
8755-7223/92/0802-0004$03.00/O
72
New
Culture
pen overnight. The new system requires a total paradigm shift in health care management, meaning that the organization must commit to total participatory involvement, collective responsibility, continuous improvement, and flexible objectives and plans. Success requires that the movement begin with organizational leadership. Officials must invest time, capital, and technical expertise in the movement. Moreover, they must support the change that the organization must undergo. This change is facilitated by a corporatewide educational program that teaches sensitivity to customer expectations, measurement systems, communication, planning, and compliance with standards that have been mutually agreed on. It is reassuring to note that across the country nursing is becoming vested in TQM and is actively involved in the process, ie, identifying the indicators of care that describe the quality outcomes expected; establishing levels or thresholds for evaluation, collecting, and evaluating data; taking actions to improve care; assessing effectiveness of these actions; and disseminating the results as necessary. The vehicle for this process is the TQM project. The TQM project is an opportunity for staff nurses to conduct a study to improve care and to share their findings and recommendations with nurses and related health care workers. Note that continuous improvement projects can occur at any level of the organizational hierarchy. Employees trained in TQM concepts are empowered to make improvements in their work; moreover, they are expected to do so. The organization believes that nurses most closely involved in care have the best ideas on how to make imand in doing so will experience better effiprovements, ciency, greater effectiveness, lower cost, and the gratitude of more satisfied patients. I am fortunate to be a part of a health care corporation that has undergone the TQM movement during the past 3 years. Recognizing that it takes at least 3 to 5 years to attain significant organizational transformation, we are encouraged by the early changes and committed to the project. TQM projects offer a rich environment for the unification of nursing service and education. Faculty can assist staff on such projects. Moreover, such projects can serve as a foundation for a more expansive research project by faculty and staff at a later time. The model is an excellent teaching opportunity, and student nurses can become involved in the process. Never before have staff nurses been so empowered to create change in health care and the rewards, especially the pleased customers, are many. American health care and nursing have much to learn from the theory of continuous improvement. Viewing the progressive movement thus far, it seems that we are establishing an even better quality of hr lith care than previously. The next generation will be grateful.
Journal of Professional Nursing, Vol 8, No 2 (March-April),
1992:
p 72
