Analysis of how the CQI process is different from TQI.

Ante- OBAMA era and post- OBAMA era, healthcare organizations in the U.S., will continue to face some serious health care challenges. Medicare, OBAMA care, Long-term care (LTC) and Insurance are some of the issues that are currently on the brinks of change. However, despite all the down play and rhetoric, OBAMA care, has offered relief to countless individuals and families. The U.S. health care industry, has continually improved their services to provide the highest quality at the best cost over the past few years. Continuous Quality Improvements (CQI) is an approach to quality management that builds upon traditional quality assurance methods by emphasizing the organization and systems: it focuses on "process" rather than the individual; it recognizes both internal and external "customers"; it promotes the need for objective data to analyze and improve processes. CQI has been used more in the manufacturing world as compared to the healthcare industry. In addition, CQI is an analytical decision making tool which allows you to see when a process is working predictably and when it is not. The core concepts of the CQI are as follows: Core Concepts of CQI Quality is defined as meeting and/or exceeding the expectations of our customers. Success is achieved through meeting the needs of those we serve. Most problems are found in processes, not in people. CQI does not seek to blame, but rather to improve processes. Unintended variation in processes can lead to unwanted variation in outcomes, and therefore we seek to reduce or eliminate unwanted variation. It is possible to achieve continual improvement through small, incremental changes using the scientific method. Continuous improvement is most effective when it becomes a natural part of the way everyday work is done. The CQI is managed and led by the individuals or members who are able to analyze and interpret the data and then translate those interpretations into action. The traditional approach to strategic planning processes starts with an analysis based on SWOT (strengths, weaknesses, opportunities, threats) or its reframed counterpart TOWS (threats, opportunities, weaknesses, strengths). Secondly, in 1987, the Joint Commission for Accreditation of Health care Organization (JCAHO) , launched the “agenda for change” , which were initiatives that were designed to base accreditation of health care organizations such as hospitals , clinics, and long-term health care facilities on implementation of a quality improvement model of management . Just here of late, quality health care is well sought after. Consequently, leaders in every field especially the health care industry are constantly striving for quantifiable evidence , evidence that validates the data that substantiates improvements initiatives or strategic methods of improvements in production of services and delivery. Hospital leaders are responsible for indoctrinating healthcare workers a strong quality driven work environment. Every professional should continue to strive to provide the best affordable quality service or health care with zero defects. For example, this Pareto chart reflects trending patterns cited during production processes. This Pareto chart tool, lean or other six sigma methodologies can be used to engage the medical providers, by providing illustrations of data that is representative of some of the varied defects, which occurred or were cited during quality inspections of production of services. The CQI system was all part of the bigger vision which is the total quality of management (TQM) system or Quality Management System (QMS). “Increased emphasis is being placed on the continuous quality improvement (CQI) education of residents of all specialties.” (Jones, K. B., Gren, L. H., & Backman, R. (2014)) Total Quality Management (TQM) is a comprehensive and structured approach to organizational management that seeks to improve the quality of products and services through ongoing refinements in response to continuous feedback. Fourthly, leaders are able to use these important pieces of information, when urgent business decision making is necessary and gage the resources needed to perform general job duties. This advantage gives the managers insight of what areas have higher risk probability, and how to address and more important create a contingency plan, in any event. Taking precautions on the front end, and addressing the issues before they happen is always good sound management. Return on Investment (ROI) provides a figure for the ratio of savings to the cost of the investment. Businesses benefit from implementing strategic goals that aim total Quality Improvements (TQI). TQI address the upstream or preventive management. The results of a TQI are most beneficial when planning for long-term business goals and quality and applicable when making assessments and gauging. It is imperative; we properly take into account the information that is possible in these reports. According to Farruggia, to accomplish the necessary transformation in TQI , the infrastructure of the organization must change. In conclusion, “in the current market economy, companies are constantly struggling to achieve a sustained competitive advantage that will enable them to improve performance, which results in increased competitiveness, and of course, profit.” (Cătălin, S. H., Bogdan, B., & Dimitrie, G. R. (2014)). Improved quality inherently lowers costs as it provides better service. The benefits of using a CQI include higher quality of service delivered, happier patients and customers, and lower costs. According to , Mayer, Jones, Dowling-Lacey, Nehchiri, Muasher, Gibbons, & Oehninger TQI is sometimes confused with quality control (QC) and quality assurance (QA), there are major differences between the three quality plans: (i) QC is an activity designed to ensure that a specific element within the laboratory is functioning correctly; (ii) QA is a comprehensive program designed to look at a laboratory as a whole and to identify problems or errors that exist in an attempt to improve the entire process; (iii) TQI is also a comprehensive monitoring process designed not only to detect and eliminate problems, but also to enhance a laboratory's performance by exploring innovation and developing flexibility and effectiveness in all processes. Quality improvement requires five essential elements for success: fostering and sustaining a culture of change and safety, developing and clarifying an understanding of the problem, involving key stakeholders, testing change strategies, and continuous monitoring of performance and reporting of findings to sustain the change. References 1. Cătălin, S. H., Bogdan, B., & Dimitrie, G. R. (2014). THE EXISTING BARRIERS IN IMPLEMENTING TOTAL QUALITY MANAGEMENT. Annals Of The University Of Oradea, Economic Science Series, 23(1), 1234-1240. 2. Jones, K. B., Gren, L. H., & Backman, R. (2014). Improving Pediatric Immunization Rates: Description of a Resident-Led Clinical Continuous Quality Improvement Project. Family Medicine, 46(8), 631. 3. Farruggia, M. J., & Farruggia, M. H. (1995). TQI: BLENDING THE OLD WITH THE NEW. Nursing Management, 26(4), 67-68. 4. Mayer, J. F., Jones, E. L., Dowling-Lacey, D., Nehchiri, F., Muasher, S. J., Gibbons, W. E., & Oehninger, S. C. (2003). Total quality improvement in the IVF laboratory: choosing indicators of quality. Reproductive Biomedicine Online (Reproductive Healthcare Limited), 7(6), 695-699.

Analyze how Health Care Providers Address Issues of Quality

Leaders in health care and providers of health care services are all striving to improve the cost and quality of services being provided to their customers. However, understanding disparities in health care access is imperative; when attempting to identify a solution. For many health service providers, the primary business organizational goal is, to always look for ways to improve the quality of life or service, life expectancy, overall physical, social, and mental health status, disease prevention by detection and disability and easy entrance into the health care system for customers. To fully address these concerns, it is necessary that everyone has equal low- cost access, to an affordable comprehensive plans and quality health care services. By addressing, some of the most chronic illnesses before-hand, will make a whole lot of financial difference in the bottom line long-term. These financial savings makes possible, funding for other critical the long –term strategic planning. Access to all sorts of information and services, is paramount in efforts to prevent and improve social, economic, mental and physical levels of accomplishments individually and as a community. Therefore, great communication, information systems (IIS) and Public Relations (PR) skills, will help to deliver pertinent information to the right audience and in timely manner. Social, economic and health equity, concerns continues plague the U.S. until this day. Equitable access to health services assures timely use of personal health services to achieve the best health care results individually. Firstly, access to health care services in the U.S., undeniably for many years has had the most negative and devastating consequence in minority communities. Fortunately, OBAMA care has been the panacea to some individuals and families when dealing with their health care woes. The "Universal healthcare" or "universal coverage" is an ideal concept that refers to a situation where everyone is covered for basic healthcare services, and no one is denied care as long as they are legal residents of the U.S. And of course with the recent illegal massive immigration influx, this too has added more complexity to an out of control situation, as it were with policies, rules and regulations. In certain countries, like Russia, and throughout the world countries offer healthcare universally, to all their citizens, in public and private sectors, and not through single-payer systems. Nevertheless, there are a few steps that can be taken to alleviate access problems and are as follows: a. provide efficient and coordinated care for patients and extend the reach of each provider b. Ensuring that all staff members are professionally trained and educated c. Removing barriers to practice, which exist at the state and federal levels, for established professions Secondly, Quality of services in health care is most important, when it applies to that individual, more so than in any other sector. “The need to improve quality of care represents a major goal of all health care systems.” (Montgomery, A., Todorova, I., Baban, A., & Panagopoulou, E. (2013) However, overall else, improving health care services depends on the patient’s ability to gain and maintain some level of consistent coverage so that they are in position to be monitored , assessed and tracked. Beyond everything, the quality concept is based on zero defects. There are several methods used for improving the quality of services and are as follows: a. Setting goals and investing in whatever catalyst will help you to reach your business goals b. Tracking and measuring your goals at increments c. Conducting interviews and surveys regularly Lastly, customer satisfaction is the most important feedback that any business manager seeks. “In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives.” (Wu, Z., Robson, S., & Hollis, B. (2013) Customer satisfaction is based purely on the experience that clients have had with your organization. The level of satisfaction determines rather or not the customer will return to your place of business or not. There are multiple ways to keep your customer coming back and are as follows: a. Thank all your customers for their business b. Try to impress your customers as if you want a pay raise c. Think about your paycheck every time you talk to a customer In conclusion, “despite decades of progress globally there is still an unacceptable level of preventable illness and death, and millions of people are denied their basic right to health.” (Grgić, M., Bilas, V., & Franc, S. (2014) Additionally, health care professionals should be informed and trained with providing information to patients in hospitals and nursing homes or any facility that are places of public accommodation covered by Title III of the ADA. In addition, all governmental organizations and other places with public accommodation, such as hotels, retail establishments, restaurants, and museums are all good starting places for reaching out to the right potential customer. Furthermore, adequately staffing the health workforce with those professionals that daily meet or exceed the needs of the people in the community in many ways, is your ideal candidate. References 1. Grgić, M., Bilas, V., & Franc, S. (2014). IMPROVEMENT OF HEALTH CARE SYSTEMS FUNCTIONING AS AN ELEMENT OF ALLIVIETING POVERTY. Global Conference On Business & Finance Proceedings, 9(1), 407-412. 2. Montgomery, A., Todorova, I., Baban, A., & Panagopoulou, E. (2013). Improving quality and safety in the hospital: The link between organizational culture, burnout, and quality of care. British Journal Of Health Psychology,18(3), 656-662. 3. Wu, Z., Robson, S., & Hollis, B. (2013). The application of hospitality elements in hospitals. Journal Of Healthcare Management / American College Of Healthcare Executives, 58(1), 47-62.

Implement a TQM System

The Health care system in the U.S. in 2014 customarily scrambles to characterize better methods for delivering cost cutting solutions. Continuous Quality Improvement (CQI), sometimes referred to as Performance and Quality Improvement (PQI), is a process of creating an environment in which management and workers strive to create constantly improving quality. Implementing a fully functional total quality management (TQM) system can be time consuming and cost your organization massive funding. Reports, with findings based on improvement efforts, are issued periodically to personnel throughout the agency and provide information useful for improving programs and practice. CONTINUOUS QUALITY IMPROVEMENT TEAM ROLES ARE AS FOLLOWS: • Chair/Facilitator - facilitates Continuous Quality Improvement meetings, champions the Continuous Quality Improvement process and coordinates input and feedback to staff. • Scribe - takes detailed meeting minutes, schedules meeting room. • Member - participates in review of issues referred to the Continuous Quality Improvement team; provides feedback to peers, stakeholders and consumers. Planning and implementing a total quality management system requires dedication from the entire team and levelheadedness enough to acknowledge that there isn’t a cure all for every type of situation. “The strategy of building performance quality policy is based on the commitment and involvement of management, identifying legislative requirements, customer requirements (stakeholders), as well as increased staff empowerment and involvement.” (PARASCHIVESCU, A. O., & CĂPRIOARĂ, F. M. (2014) Realistically, a truly functional (TQM) system is not exactly a cookie cutter situation and remains a work in progress (WIP). Some familiarity may exist between organizations when being compared; however each organization posses its own DNA, as it were, make-up, culture, business ethic and practices, thus creating unique opportunities for vast improvements individually. “Recent research shows that about 90% of buyers in the international market consider quality as having at least equal importance with price in making the decision to purchase.” (Cătălin, S. H., Bogdan, B., & Dimitrie, G. R. (2014) There are many advantages to implementing a TQM than disadvantages and are as follows: a. Process improvement b. Defect prevention c. Priority of effort d. Developing cause-effect relationships e. Measuring system capacity F. Developing improvement checklist and check forms G. Helping teams make better decisions H. Developing operational definitions I. Separating trivial from significant needs J. Observing behavior changes over a period of time Secondly, total quality management (TQM) works by measurement: finding the right criteria to assess and track quality levels. “However, recent quality researchers have found contradictory performance evidence highlighting that the success of TQM might depend on various contextual factors.” Wiengarten, F., Fynes, B., Cheng, E. T., & Chavez, R. (2013). In addition, quality in health care is often measured by health outcomes and patient satisfaction that are found in surveys and other feedback from patients. There are three basic concepts to TQM: a focus on customers, continuous improvement and learning, and participation and teamwork by all employees. Implementing a TQM is a step-by-step process and is as follows: a. Top management learns about and decides to commit to TQM. TQM is identified as one of the organization’s strategies. b. The organization assesses current culture, customer satisfaction, and quality management systems. c. Top management identifies core values and principles to be used, and communicates them. d. A TQM master plan is developed on the basis of steps 1, 2, and 3. e. The organization identifies and prioritizes customer demands and aligns product and services to meet those demands. f. Management maps the critical processes through which the organization meets its customer’s needs. g. Management oversees the formation of teams for process improvement efforts. h. The momentum of the TQM effort is managed by the steering committee. i. Managers contribute individually to the effort through providing planning, training, coaching, or other method. j. Daily process management and standardization take place. k. Progress is evaluated and the plan is revised as needed. l. Constant employee awareness and feedback on status are provided and a reward/recognition process is established. Health care organizations in the U.S. are anxiously implementing quality improvement programs to further meet and attempt to exceed patient demands of improving service and clinical quality in health care. “TQM practices have been principally studied in organizations of larger size, but little has been investigated in relation to Small and Medium-sized Enterprises (SMEs), as they present inimitable challenges to quality management due to their diverse features.” (Kaur, P., & Sharma, S. K. (2014) The implementation process requires spending substantial time, effort, and money in order to master and appreciate a TQM. There are five strategies in developing a TQM and are as follows: 1. The TQM element approach a. The TQM element approach takes key business processes and/or organizational units and uses the tools of TQM to foster improvements. This method was widely used in the early 1980s as companies tried to implement parts of TQM as they learned them. b. Examples of this approach include quality circles, statistical process control, Taguchi methods, and quality function deployment. 2. The guru approach a. The guru approach uses the teachings and writings of one or more of the leading quality thinkers as a guide against which to determine where the organization has deficiencies. Then, the organization makes appropriate changes to remedy those deficiencies. b. For example, managers might study Deming’s 14 point or attend the Crosby College. They would then work on implementing the approach learned. 3. The organization model approach a. In this approach, individuals or teams visit organization that have taken a leadership role in TQM and determine their processes and reasons for success. They then integrate these ideas with their on ideas to develop an organization model adapted for their specific organization. b. This method was used widely in the late 1980s and is exemplified by the initial recipients of the Malcolm Baldrige Quality Award. 4. The Japanese total quality approach a. Organizations using the Japanese total quality approach examine the detailed implementation techniques and strategies employed by Deming Prize –winning companies and use this experience to develop a long-range master plan for in-house use. b. This approach was used by Florida Power and Light – among others – to implement TQM and to compete for and win the Deming Prize. 5. The award criteria approach a. When using this model, an organization uses the criteria of a quality award, for example, the Deming Prize, the European Quality Award, or the Malcolm Baldrige National Quality Award, to identify areas for improvement. Under this approach, TQM implementation focuses on meeting specific award criteria. b. Although some argue that his is not an appropriate use fo award criteria, some organizations do use this approach and it can result in improvement. In conclusion, according to the Journal of Transnational Management, “TQM primarily focuses on the production of quality goods and services and the delivery of excellent customer service; however, its success increases when it is extended to the entire company.” TQM has a quantitative character; it emphasizes measuring outcomes to gauge quality levels. Implementing a TQM involves embracing change and revolves around the following: a. Commitment by Senior Management and all employees b. Effective strategy, vision, mission and goals c. Customer/ Supplier relationships d. Communication e. Tools and techniques for improvement f. Team work g. Systems to facilitate improvement h. and most of all TRUST The future of Continuous Quality Improvement (CQI) in health care seems very tentative, on the grounds, that it only started receiving recognition here of late, and went on for decades or even generations being totally ignored, as it were. I would hope that just due attention and focus will bring direct resources to those broken deficiencies in the system. The lack of communicating impedes; point number one which is commitment by management. This causes the urgency and seriousness of CQI or TQM in health care to be dismissed somehow. This is problematic and directly opposes business strategic initiatives in quality and across the board. Recent attention of system fallacies and scandals has sown seeds in the U.S. population, causing even more skeptics. Again, in my opinion CQI is a work in progress like everything else in this world, imperfection is constant. Improvements have been accounted for and the relief to some I’m sure is stupendous, but the problem is colossal and will require many years of research and development. Proper implementation of TQM has significant positive potential in quality, customer service and internal and external customers’ satisfaction. Skillful leadership is manifested by improving the bottom line. Leadership and TQM, succors funds for future projects in quality service improvement initiatives and other strategic projects, as well. Meeting or exceeding customer and company projections and expectations is a result of control mechanisms in effect. There are a host of those involved in CONTINUOUS QUALITY IMPROVEMENT AND ARE AS FOLLOWS: • Persons & families served • Employees, volunteers & consultants • Members of advisory boards • Consumer advocates • All levels of agency staff References 1. Cătălin, S. H., Bogdan, B., & Dimitrie, G. R. (2014). THE EXISTING BARRIERS IN IMPLEMENTING TOTAL QUALITY MANAGEMENT. Annals Of The University Of Oradea, Economic Science Series, 23(1), 1234-1240. 2. Kaur, P., & Sharma, S. K. (2014). Evaluating the Relationship and Influence of Critical Success Factors of TQM on Business Performance: Evidence from SMEs of Manufacturing Sector. IUP Journal Of Operations Management, 13(4), 17-30. 3. PARASCHIVESCU, A. O., & CĂPRIOARĂ, F. M. (2014). Strategic Quality Management. Economy Transdisciplinarity Cognition, 17(1), 19-27. 4. Selim Zaim, Nizamettin Bayyurt, Ali Turkyilmaz, Nihat Solakoglu & Halil Zaim (2008): Measuring and Evaluating Efficiency of Hospitals Through Total Quality Management, Journal of Transnational Management, 12:4, 77-97 5. Wiengarten, F., Fynes, B., Cheng, E. T., & Chavez, R. (2013). Taking an innovative approach to quality practices: exploring the importance of a company’s innovativeness on the success of TQM practices. International Journal Of Production Research, 51(10), 3055-3074. doi:10.1080/00207543.2012.752609

Several ways quality circles and feedback loops can be used within health care organizations to strengthen quality management initiatives and activities.

Quality circles are groups of employees that meet regularly to consider ways of resolving problems and improving production in their organization. According to online encyclopedia, “A quality circle is a participatory management technique that enlists the help of employees in solving problems related to their own jobs.” The mass majority of these circles consist of employees working together in an operation, who meet at regular intervals to discuss problems of quality and to devise solutions for improvements. In my opinion, quality circles work best if led by an on-site supervisor or a senior worker independent of production and production management. Secondly, quality staff or quality circles and feedback groups are normally small in number and often transfer information to upper or senior management by way of Pareto charts and graphs and other data, which is the greatest expose of trending quality patterns. Exhibit 1 Thirdly, according to an online blog, “Quality circles and feedback loops are curriculums that are composed of employees or consumers that aid companies and healthcare organizations in arbitrating, analyzing, and solving work-related issues, presenting the solution to supervisors, and implementing the solutions themselves to improve performance in health care organizations.” Feedback loops are often described as people, this particular feedback group is an automated interactive voice response system (IVRS) that initiates a phone conversation with a patient with their permission, and then asks questions about their visit with the healthcare organization they visited. There are many pros and cons as it relates to this type of response system. There aren’t any Information Technology systems that are obsolete, when it comes to technical or system issues and breakdowns. Fourthly, online sources, noted that quality circles and feedback loops are programs made up of employees and or consumers that assist companies and healthcare organizations in determining problematical issues, communicating what they believe problems are, and finding potential resolutions to repair the problem. Members of these groups must be prepared to work as a collectively and objectively, as a unit to improve outcomes and to promote efficiency while reducing errors .There are a few ways quality circles and feedback loops can be used within health care organizations to strengthen quality management initiatives and activities and are as follows: Quality Circle is a form of participation management. Quality Circle is a human resource development technique. Quality Circle is a problem solving technique. The sessions can be used as a brain storming session. This process provides the healthcare organization needed information to compile and provide a better value for patient satisfaction. In conclusion, with regard to quality, quality control circle (QCC) members must be able to perform their inspections in an environment of trust and empowerment and without fear of retaliation or obstruction of power by upper management. The reported results must remain unbiased and neutral. “Introduction Quality circles, as a participatory management technique, offer one alternative for dealing with frustration and discontent of today’s workers.” (Hosseinabadi, R., Karampourian, A., Beiranvand, S., & Pournia, Y. (2013). Furthermore, it is encouraged that upper management appoint a manager as the mentor of the team, charged with helping members of the circle achieve their objectives. Production managers, in no way should not have direct influence or say over the independent quality circles, as this is conflict of interest. Likewise, if properly implemented, quality circles and feedback loops can be utilized to improve these certain functions within your organization and are as follows: a. Problem identification b. Problem selection c. Problem analysis d. Generate alternative solutions e. Select the most appropriate solution f. Prepare plan of action g. Present solution to management h. Implement a solution References 1. Cahil, S. (2013). Thoughtful feedback loop: A nurse’s approach to personal and organizational improvement. American Nurse Today, 8(6). 2. Hosseinabadi, R., Karampourian, A., Beiranvand, S., & Pournia, Y. (2013). The effect of quality circles on job satisfaction and quality of work-life of staff in emergency medical services. International Emergency Nursing,21264-270. doi:10.1016/j.ienj.2012.10.002 3. McLaughlin, C. P., & Kaluzny, A. D. (2013). Continuous quality improvement in health care. Sudbury, MA Jones and Bartlett, ISBN:9780763781545 Enter the Holiday Sweepstakes for a chance to win a Generous Minims Gift Set. A $56 Value. Valid 12/2-12/29