Download Kotter's Change Model, Accreditation, & Juran's Trilogy: Improving Organizations and more Exams Total Quality Management (TQM) in PDF only on Docsity!
1. Discuss Kotter’s 8 Step to quality change
Research carried out by the American change and leadership guru John Kotter has proved that major change efforts unfortunately do not always have the desired outcome. He found out that there is only a 30% chance of organisational change success. This is why organizations implement changes unsuccessfully and fail to achieve the intended result. John Kotter introduced the “Kotter’s 8 Step Change Model” to improve an organization’s ability to change and to increase its chances of success. By following this step plan organizations can avoid failure and become adept at implementing change. As a result, organizations no longer need to adjust the changes and they will increase their chances of success.
Change success factors
Employees do not always experience change as something positive. However, they are important when it comes to the implementation of change. Following the Kotters eight stage model plan will help organizations to succeed at implementing change. The first three steps of Kotter’s 8 Step Change Model are about creating the right climate for change, steps 4 up to 6 and link the change to the organization. Steps 7 and 8 are aimed at the implementation and consolidation of the change:
- Create a sense of urgency This first step of Kotter’s 8 Step Change Model is the most important step according to John Kotter. By making employees aware of the need and urgency for change, support will be created. This requires and open, honest and convincing dialogue. This convinces employees of the importance of taking action. This could be accomplished by talking with them about potential threats or by discussing possible solutions.
- Create a guiding coalition It is a good idea to establish a project team that can occupy itself with the changes the organization wants to implement. This group manages all efforts and encourages the employees to cooperate and take a constructive approach. Preferably, this coalition is made up from employees working in different jobs and positions so that all employees can rely on the group and identify themselves with the team members. Because of the open character, the groups can also function as a sounding board, which enables an open communication.
- Create a vision for change Formulating a clear vision can help everyone understand what the organization is trying to achieve within the agreed time frame. It makes changes more concrete and creates support to implement them. The ideas of employees can be incorporated in the vision, so that they will accept the vision faster. Linking the adopted vision to strategies will help employees to achieve their goals.
- Communicate the vision The most important objective of step 4 of Kotter’s 8 Step Change Model is to create support and acceptance among the employees. This can only be achieved by talking about the new vision with the employees at every chance you get and by taking their opinions, concerns and anxieties seriously. The new vision must be fully adopted across the entire organization.
- Remove obstacles Before change is accepted at all levels, it is crucial to change or, if necessary, remove obstacles that could undermine the vision. By entering into dialogue with all employees, it will become clear who are resisting the change. To encourage acceptance of the vision by the employees, it helps when their ideas are incorporated and implemented in the change process.
- Create short-term wins Nothing motivates more than success. Create short-term goals so that the employees have a clear idea of what is going on. When the goals have been met, the employees will be motivated to fine tune and expand the change. By acknowledging and rewarding employees who are closely involved in the change process, it will be clear across the board that the company is changing course.
- Quality Planning : As with all management activities and processes, Quality journey begins with planning the activities that needs to be done to adhere to the Vision, Mission and Goals of the organization and to comply with customer and compliance requirements.Quality Planning comprises of i) Understanding the customer, ii) Determining their needs, iii) Defining the product/service features, specifications iv)Designing the product/service v) Devising the processes that will enable to meet the customer needs.
- Quality Control : Once the processes are defined, the responsibility is now with operations, to adhere to the processes and specifications required by the product/service. For this purpose periodic checks and inspection has to be done, metrics need to be tracked, to ensure that the process is in control and meets specifications and the metrics need the set target. Wherever there is a defect a corrective and preventive action needs to be done, and root cause has to be arrived at. Also the deviation in the metrics and process audit results need to be monitored and corrected for meeting the required target as specified by the processes.
- Quality Improvement : However robust the process design and the product features are, there are chances that it may fail to meet customer requirements and design targets. It might be due to some special causes that are present in the system and might be due to change in business scenarios, customer requirements, market completion and many more forces. The role of Quality Improvement is to identify and prove the need for improvement from the exiting performance levels even though they meet the
target and devise means and ways to achieve the new target and implement them successfully. All the three processes are interlinked and will affect one another in due course of the journey. Thus the processes are corrected individually and streamlined to help each other in Quality Management journey, the end objective.
4. what do mean by health grades? Healthgrades is the leading online resource for patients to find and connect with the right doctor or hospital. We help about a million people a day find and connect with healthcare providers. You can search for top-rated doctors or hospitals on our site, read what other patients have to say about them, and book an appointment. We also have a large library of slideshows, articles and videos to help you learn more about the specific condition you have or the procedure you need. Healthgrades is an online database of doctors, dentists, and hospitals that has over 100 million users and has amassed data on more than three million U.S. healthcare providers. When a patient searches Google for your practice, Healthgrades will likely show up on the first page. On Healthgrades, potential patients can search by doctor name, office name, specialty, condition or procedure. While Healthgrades creates physicians’ profiles based on information from government and commercially available services, physicians can claim and edit these profiles. Once a profile is claimed, you will have the ability to add photos, age, gender, information about specialties, a physician’s background such as when they graduated and information on scheduling appointments. You can claim your practice’s profile, but the main focus is on individuals. On Healthgrades, patients can complete patient satisfaction surveys about a practice or physician. The surveys evaluate the office and staff, wait time, experience with the doctor and likelihood of recommending the doctor to family and friends. Pros : Healthgrades is very user-friendly for patients. It doesn’t ask patients to answer questions. Instead, they simply complete a survey. If you have a large number of physicians in your office, you can contact the support center and submit a spreadsheet with your physicians’ information. The support center will then work to update all of the data for you without a fee. Healthgrades will also send physicians personalized, printed postcards with a URL to their profile that can be given to patients. Cons : Although physicians can post a general response to patient surveys completed, they cannot reply individually to lowly-graded surveys.
Structural Measures Structural measures give consumers a sense of a health care provider’s capacity, systems, and processes to provide high-quality care. For example: Whether the health care organization uses electronic medical records or medication order entry systems. The number or proportion of board-certified physicians. The ratio of providers to patients. Process Measures Process measures indicate what a provider does to maintain or improve health, either for healthy people or for those diagnosed with a health care condition. These measures typically reflect generally accepted recommendations for clinical practice. For example: The percentage of people receiving preventive services (such as mammograms or immunizations). The percentage of people with diabetes who had their blood sugar tested and controlled. Process measures can inform consumers about medical care they may expect to receive for a given condition or disease, and can contribute toward improving health outcomes. The majority of health care quality measures used for public reporting are process measures. Outcome Measures Outcome measures reflect the impact of the health care service or intervention on the health status of patients. For example: The percentage of patients who died as a result of surgery (surgical mortality rates). The rate of surgical complications or hospital-acquired infections. Outcome measures may seem to represent the “gold standard” in measuring quality, but an outcome is the result of numerous factors, many beyond providers’ control. Risk-adjustment methods—mathematical models that
correct for differing characteristics within a population, such as patient health status—can help account for these factors. However, the science of risk adjustment is still evolving. Experts acknowledge that better risk- adjustment methods are needed to minimize the reporting of misleading or even inaccurate information about health care quality.
7. Discuss in details Malcolm Baldrige quality award with its purpose and criteria for performance enhancement named after Malcolm Baldrige, who was the U.S. Secretary of Commerce during the Ronald Reagan administration, from 1981 to 1987. Breaking Down the Malcolm Baldrige Award The Malcolm Baldrige National Quality Award was developed in the late 1980s by the Department of Commerce to facilitate competition among U.S. companies. The award is the highest level of recognition for performance excellence that a U.S. company can receive. Up to 18 awards are given annually across six categories: . Manufacturing . Service . Small Business . Education . Healthcare . Nonprofit Recipients of the MBNQA must share information about their company performance and their practices with other companies but are not required to share proprietary information. The information is shared through two annual conferences: 1.Quest for Excellence Conference 2.Baldrige Fall Conference Purpose of the Malcolm Baldrige Award The main purpose of the Baldrige Award is to: . Raise awareness about the importance of performance excellence . Recognize companies that show performance excellence and pass on this information to other organizations to tailor it for their own needs
. Product reliability . New product sales . Customer engagement and satisfaction Recipients of the Malcolm Baldrige Award Nearly 1,700 American organizations have applied for the Baldrige Award, with only 113 Baldrige Awards being presented to 106 organizations. The 2017 Baldrige Award recipients are: Bristol Tennessee Essential Services, Bristol, TN – Small business sector Stellar Solutions , Palo Alto, CA – Small business sector City of Fort Collins, Fort Collins, CO – Nonprofit sector Castle Medical Center , Kailua, HI – Healthcare sector Southcentral Foundation , Anchorage, AK – Healthcare sector 8. Write down the benefit, disadvantages of TQM. Discuss the principles The advantages of total quality management (TQM) include: 1.Cost reduction. When applied consistently over time, TQM can reduce costs throughout an organization, especially in the areas of scrap, rework, field service, and warranty cost reduction. Since these cost reductions flow straight through to bottom-line profits without any additional costs being incurred, there can be a startling increase in profitability. 2.Customer satisfaction. Since the company has better products and services, and its interactions with customers are relatively error-free, there should be fewer customer complaints. Fewer complaints may also mean that the resources devoted to customer service can be reduced. A higher level of customer satisfaction may also lead to increased market share, as existing customers act on the company's behalf to bring in more customers. 3.Defect reduction. TQM has a strong emphasis on improving quality within a process, rather than inspecting quality into a process. This not only reduces the time needed to fix errors, but makes it less necessary to employ a team of quality assurance personnel.
4.Morale. The ongoing and proven success of TQM, and in particular the participation of employees in that success can lead to a noticeable improvement in employee morale, which in turn reduces employee turnover, and therefore reduces the cost of hiring and training new employees. Disadvantages 1) Production Disruption
Implementing a Total Quality Management system in a company requires
extensive training of employees and these requires them to take some time of
their day to day work duties.
While the improvements do reduce lead time, eliminate waste and improve
productivity, the beginning stages of implementing Total Quality Management in
an organization can reduce worker output.
2) Employee Resistance
Total Quality Management requires change in mindset, attitude and methods for
performing their jobs. When management does not effectively communicate the
team approach of Total Quality Management, workers may become fearful,
which leads to employee resistance. When workers resist the program, it can
lower employee morale and productivity for the business.
3) Quality is Expensive
TQM is expensive to implement. Implementation often comes with additional
training costs, team-development costs, infrastructural improvement costs,
consultant fees and the like.
4) Discourages Creativity
TQM focus on task standardization to ensure consistency discourages creativity
and innovation. It also discourages new ideas that can possibly improve
productivity
Principles of TQM The key principles of TQM are as following: Management Commitment
The Six Cs required for proper implementation of a TQM are given below.
- There must be a quality improvement commitment from all employees of the organization.
- Organization must follow a modern quality improvement culture on a constant basis.
- Continuous improvement must take place in all policies, procedures, and activities laid down by management for the organization.
- Cooperation and experience of employees must be utilized to improve strategies and enhance performance.
- Focus on customers' requirements and satisfaction of their expectations are very important for long-term survival of the business.
- Effective controls must be laid down to monitor and measure the real performance of the business. 6 Cs of TQM The 6 Cs of TQM process are depicted in the following image. Now let's discuss briefly the Six Cs of TQM that are very important and essential to successfully implement the Total Quality Management.
- Commitment from Employees In an organization , the Total Quality Management (TQM) policies shall be developed. These policies shall be binding on all employees of the organization. Due to this, the quality improvement will become an essential part of everyone’s work. Furthermore, this will ensure a Quality Improvement commitment from all the employees for the work deployed to them.
- Quality Improvement Culture There shall be a Quality Improvement Culture in the organization. The culture followed needs to be modernized on a continuous basis to encourage employee's feedback. This will ensure employee comfort towards effective administration of allotted work.
- Continuous Improvement in Process Total Quality Management (TQM) is a continuous process and not a program. This requires constant improvement in all the related policies, procedures and controls laid down by the management. There should be a continuous search of the proficiency to do the task better. This will always result in scope for improvement, although such improvement may be small.
- Cooperation from Employees The application of Total Quality Management (TQM) is in direct relation with the Total Employee Involvement during and after the implementation of the same. The experience and cooperation of the employees are utilized in the development of improved strategies and performance measures.
- Focus on Customer Requirements Total Quality Management (TQM) process shall be prepared by focusing on customers' requirements and their expectations from the products and services. In today's market, customer requires and expects perfect goods and services with zero defects. Focus on customer requirement is significant to survive in long-term and to build prominent relationship with the customers.
Continuous improvement must deal not only with improving results, but more importantly with improving capabilities to produce better results in the future. The five major areas of focus for capability improvement are demand generation, supply generation, technology, operations and people capability. A central principle of TQM is that mistakes may be made by people, but most of them are caused, or at least permitted, by faulty systems and processes. This means that the root cause of such mistakes can be identified and eliminated, and repetition can be prevented by changing the process.^1 There are three major mechanisms of prevention:
. Preventing mistakes (defects) from occurring (mistake-proofing or poka-yoke). . Where mistakes can’t be absolutely prevented, detecting them early to prevent them being passed down the value-added chain (inspection at source or by the next operation). . Where mistakes recur, stopping production until the process can be corrected, to prevent the production of more defects. (stop in time). 11. Briefly discuss the dimensions of quality in Healthcare Berry, Parasuram and Zeithaml conducted an extensive research in service quality and identified 10 criteria used by consumers in evaluating service quality as shown in the figure below: Ten determinants of service quality Understanding – It involves knowing customers by making more efforts to understand the customer's requirements and wants. Tangibles – It encompasses the physical evidence of the service. Security – It is the liberty from doubts or danger risks. Credibility – It is nothing but honesty, believability and trustworthiness. Communication – It is the process where the customers are informed in their own understandable language as well as it encompasses listening to customers. Communication means that the business has to make several adjustments for various customers that in turn results in increasing the sophistication level with a well educated customer as well as speaking. Courtesy – It involves friendly attitude as well as nature of personal politeness.
Access – It involves availability as well as easy method of contact. Competence – It means possessing the needed skills and knowledge for the purpose of performing the services. Reliability – It involves dependability and performance consistency. Reliability means that the service is done correctly the very initial time by the business and it also means that the business honors its premises. Responsiveness – It means the willingness of a worker for the sake OF providing service. Responsiveness encompasses timeliness of service.
12. Discuss NABH, JCI, Australian system QCI Accreditation NABH The National Accreditation Board for Hospitals & Healthcare Providers (NABH) Standards is today the highest benchmark standard for hospital quality in India. Though developed by the Quality Council of India on the lines of International Accreditation Standards like the JCI, ACHS and the Canadian Hospital Accreditation Standards, the NABH is however seen as a more practical set of Standards, topical and very relevant to India's unique healthcare system requirements. Within just 2 years of its launch, the Indian Accreditation Standards, the NABH was accepted by ISQUa, the International Society for Quality Assurance in Healthcare, as an International Accreditation on par with the world's best. Patients are the biggest beneficiaries from the NABH Accreditation, as it results in a high quality of care and patient safety. The patients get services by credential medical staff. Rights of patients are respected and protected. Patient satisfaction is regularly evaluated. Accreditation also benefits the staff of the hospital as it provides for continuous learning, good working environment, leadership and above all ownership of clinical processes. NABH Accreditation to a hospital stimulates continuous improvement. It enables the Hospital in demonstrating commitment to quality care and raises the community confidence in the services provided by the Hospital. It also provides opportunity to benchmark with the best. Finally, the NABH is expected to provide an objective system of empanelment by Insurance and other Third Parties Administrators. Accreditation provides access to reliable and certified information on facilities, infrastructure and level of care, a need being felt increasingly by the Indian Insurance Companies who have recently come out with a three tier package segmenting hospitals into A,B& C categories based on which tariffs for cashless hospitalization treatments will be set. The NABH Accreditation will naturally help Hospital to be in the A Category.
13. Merits and demerit of Taguchis’s Ideas of quality management Advantages and Disadvantages An advantage of the Taguchi method is that it emphasizes a mean performance characteristic value close to the target value rather than a value within certain specification limits, thus improving the product quality. Additionally, Taguchi's method for experimental design is straightforward and easy to apply to many engineering situations, making it a powerful yet simple tool. It can be used to quickly narrow down the scope of a research project or to identify problems in a manufacturing process from data already in existence. Also, the Taguchi method allows for the analysis of many different parameters without a prohibitively high amount of experimentation. For example, a process with 8 variables, each with 3 states, would require 6561 (38) experiments to test all variables. However using Taguchi's orthogonal arrays, only 18 experiments are necessary, or less than .3% of the original number of experiments. In this way, it allows for the identification of key parameters that have the most effect on the performance characteristic value so that further experimentation on these parameters can be performed and the parameters that have little effect can be ignored. The main disadvantage of the Taguchi method is that the results obtained are only relative and do not exactly indicate what parameter has the highest effect on the performance characteristic value. Also, since orthogonal arrays do not test all variable combinations, this method should not be used with all relationships between all variables are needed. The Taguchi method has been criticized in the literature for difficulty in accounting for interactions between parameters. Another limitation is that the Taguchi methods are offline, and therefore inappropriate for a dynamically changing process such as a simulation study. Furthermore, since Taguchi methods deal with designing quality in rather than correcting for poor quality, they are applied most effectively at early stages of process development. After design variables are specified, use of experimental design may be less cost effective. 14. National association of health care quality (NAHQ) The National Association for Healthcare Quality (NAHQ) is the leader in health care quality competencies. NAHQ provides a strategic advantage to health care professionals and the organizations they serve by developing and evolving competencies in health care quality that result in better patient and financial outcomes to support the goals of health care value. NAHQ offers the industry standard certification in health care quality and the Certified Professional in Healthcare Quality® held by almost 13,000 health care professionals today. NAHQ also offers extensive educational programming, networking opportunities, and career resources to help health care professionals meet the challenges they face. Founded in 1976, the National Association for Healthcare Quality (NAHQ) is the only organization dedicated to healthcare quality professionals, defining the standard of excellence
for the profession, and equipping professionals and organizations across the continuum of healthcare to meet these standards. NAHQ offers the only accredited certification in healthcare quality (the CPHQ), extensive educational programming, networking opportunities, and career resources to help our members meet the challenges they face and demonstrate their value. Healthcare quality professionals are an indispensable part of the healthcare team, and NAHQ is committed to you and your success at all levels, from new quality specialist to experienced executive. Mission To prepare a coordinated, competent workforce to lead and advance healthcare quality across the continuum of healthcare. Vision The healthcare quality profession is recognized and valued as essential. Role of the NAHQ Healthcare quality exists to ensure efficient and effective care of the patient while in the healthcare setting. There are six attributes of this particular field:
. Safety . Effectiveness . Patient driven . Timely . Efficient . Equitable The National Association for Healthcare Quality is an organization that supports and provides resources to professionals in the healthcare quality setting. Healthcare quality is a rapidly growing segment of the healthcare industry, serving to improve the overall quality and efficiency of healthcare services that patients receive. The NAHQ serves in multiple capacities. The main role the NAHQ provides is certification for healthcare quality professionals to become a CPHQ , Certified Professional in Healthcare Quality. The NAHQ provides preparation programs
