Methodist Healthcare Policy and Procedure Manual

The terms medical record, health record, and medical chart are used interchangeably when describing the systematic documentation of a single patient's medical history and care across time within one particular health care provider's jurisdiction. Medical records includes a variety of types of "notes" entered over time by health care professionals, recording observations and administration of drugs and therapies, orders for the administration of drugs and therapies, test results, x-rays, reports, etc, according to an online dictionary. A patient's individual medical record identifies the patient and contains information regarding the patient's case history at a particular provider. “The U.S. health care system is in the midst of transforming from a fee-for-service system to a value-based system that delivers high-quality and cost-effective care.” (Koltov, M. K., & Damle, N. S. 2014) According to, the Handbook for Physicians and Medical Office Staff handbook, liability insurers, defense attorneys, and third-party payers remind physicians and other health professionals that the safety of patients, the outcome of litigation and the promptness of reimbursement depend on the adequacy, legibility, completeness, timeliness and accuracy of medical records. Firstly, medical records documentation is important for multiple reasons and has various operational and functional roles in the medical industry. Patient safety and provider protection are both protected by the information that is captured in the patient’s medical record. Every time you visit a hospital, physician or other health care provider, a record of your visit is made. This record may include your symptoms, examination and test results, diagnosis, treatment and plans for future care or treatment. Secondly, Methodist Healthcare organization addresses these issues by fostering the concept of top quality and continuity of care. Methodist Healthcare organization creates a means of communication between it’s’ providers and members about patient’s health status, preventive health services, treatment, planning, and delivery of care. In addition, Methodist Healthcare medical record standards reflect the importance of confidentiality and accessibility by authorized users only. Methodist healthcare weaknesses unfavorably are within the ability to oversee and manage risk management concerns relating to the mismanagement of records or improper disclosure of protected health information (PHI) that can lead to regulatory sanctions, network exclusions, and could affect licensure, accreditation, and Medicare and Medicaid reimbursement and participation. Medical records aide physicians in medical malpractice claims management and loss prevention activities. Upon any request being made, a complete documentation of any medical encounter must be made available. Promotion of continuous quality improvements includes good sound record documentation standards that reflect the importance of complete, timely, and accurate health information and are as follows: Member identifiers appear on every piece of documentation Entries are legible to others and are recorded in black or blue ink if on paper Entries are dated and authenticated by the author Documentation is made at the time service is provided Documentation must support all codes submitted Only standard medical abbreviations should be used in documentation All patient encounters, including telephone, fax, and electronic message exchanges are documented Documentation of any advance directives is in a prominent part of a member's medical record and includes whether or not a member has executed an advance directive, as well as documentation of any information about advance directives that was made available to the member Promptly forwarding the records ensures that the personal physician has a complete medical record on file The strength of Methodist healthcare is the ability to ensure compliance with laws, rules and regulations, and other benchmarks such as healthcare policies and procedures, Methodist healthcare managers are able to protect against unauthorized access and release, medical record management policies should address the physical security of paper-based documents, electronic record system security measures, and personnel access to both electronic and paper records. Methodist healthcare has a significant number of policies and procedures to cover all of the requirements that need to be covered. Certain responsibilities that meet and exceed customer expectation are as follows: Maintaining the privacy of your health record; Providing you with a copy of this Notice; Abiding by the terms of this Notice; Notifying you if we are unable to agree to a requested amendment or restriction; and Accommodating reasonable requests you may have to communicate health information by alternative means or at alternative locations. In conclusion, sound medical record documentation is important because it is being governed by gobs of laws on both state and federal levels. Medical records contain sensitive information, and increasing computerization and other policy factors have increased threats to their privacy. There are threats to privacy from modern record-keeping systems and from legislation. “Electronic health record systems contain clinically detailed data from large populations of patients that could significantly enrich public health surveillance.” (Vogel, J., Brown, J. S., Land, T., Platt, R., & Klompas, M. 2014) In order to protect patients these protectors have been established and are as follows:  Medical Ethics  The privacy portion of the Hippocratic Oath: "Whatsoever I shall see or hear in the course of my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets."  The 1992 AMA statement, which states that medical information must be confidential to the greatest possible degree.  Laws and Other Legal Protection  The Privacy Act of 1974, which states that no federal agency may disclose information without the consent of the person. Agencies must also meet certain requirements for protecting the information. Federal Laws only cover federal agencies, such as Medicare and Medicaid. The bulk of medical records are covered by various, inconsistent and often ineffectual state laws. State Laws , this document allows you to look at the privacy laws, including medical privacy laws, for each state. Only about half of the states guarantee patients the right to see their medical records (CR, Oct. 1994, p. 629). You can obtain more information by looking in your state code or by contacting Privacy Journal.  Tort Law. This may include defamation, breach of contract, and other privacy-related torts. To determine whether your policies comply with state and federal laws regarding the storage and release of PHI, consult with an attorney about the following issues: Creating policies and procedures pertaining to both the on-site and off-site storage of medical records. Accurately labeling and storing records to aid in record retrieval and prevent improper access and/or destruction. Establishing functional redundancy to allow for medical record storage system back-up should the primary storage system fail Entering into Business Associate Agreements with any outside vendors with whom the practice may contract to store, retrieve, and/or destroy medical records on behalf of the practice. Tailoring policies and procedures to address special considerations pertaining to the electronic medical records (e.g., protections by password and encryption, storage and protection of metadata, etc.). Nevertheless, the biggest challenges are with implementing and using electronic medical records. Healthcare providers are experiencing difficulty with using the new systems and therefore, seek other individuals to enter the data into the systems for them. “A failure by physicians to take a lead on this will mean that they may become victims of pressure or legislation.” (Patrick, K. 2014). Documenting the information on both paper and in a computer system has overwhelmed some providers. Furthermore, the lacks of familiarity with the systems have impeded the progress and therefore some users are reluctant to the change. However, opportunities for improvements are possible if the providers will buy into the quality initiative and get the best results out of the system. References 1.) Patrick, K. (2014). Patients and their medical records: it is time to embrace transparency. CMAJ: Canadian Medical Association Journal = Journal De L'association Medicale Canadienne, 186(11), 811. doi:10.1503/cmaj.140834 2.) Koltov, M. K., & Damle, N. S. (2014). Health policy basics: physician quality reporting system. Annals Of Internal Medicine, 161(5), 365-367. doi:10.7326/M14-0786 3.) Vogel, J., Brown, J. S., Land, T., Platt, R., & Klompas, M. (2014). MDPHnet: Secure, Distributed Sharing of Electronic Health Record Data for Public Health Surveillance, Evaluation, and Planning. American Journal Of Public Health, 104(12), 2265-2270. doi:10.2105/AJPH.2014.302103

Motivation Touchstone

My plan to survive Will be a dive While I Let my Soul drive Not to look back It will only set me back But to look ahead Instead Written By: Kenya Nichols

International Management Considerations

From: Kenya Nichols Date: 1/2/2015 As the global marketplace continues to develop, companies engage in international business for many reasons. The main reason is to gain value for their organizations which, is the primary motive. In addition, expanding sales, acquiring resources and minimizing risk are also some important factors that are taken into consideration. The pursuit of international sales usually increases the potential market and potential profits. However, acquiring resources requires that the producers and distributors track down products, services, resources and other components from foreign companies. To gain a competitive edge companies often promote resources that cut cost. The prospect of gaining a competitive advantage can be improved by improving the quality of the product or by differentiating your products from those of competitors. One significant reason the global market makes sense is it is techchnological because of improved transportation and communication opportunities today, trade is now more practical. As a result, consumers and businesses now have access to the best products from many different countries. On the other hand, regrettably, culture is ambiguous concern for many marketers since it is inherently obscure and often strenuous to perceive. One may breach the cultural patterns of another country without being in the know. Foreign sources propositions companies with lower costs new or better products and additional operating knowledge. In essential, minimizing risk involving sales and profits is the key when negotiating different business cycles in foreign operating companies. The culminating facts are that sales decrease or grow more slowly in a country that’s in a recession and increase or grow more rapidly in one that’s sound economically. Merchandising exports and imports are some of the most notable modes if international business amongst small companies, which is also the companies most international economic transactions. Presently, services exports and imports take many forms, and is the fastest growth sector in international trade. Service exports and imports are international non-product sales and purchases. The most important are tourism and transportation, service performance and asset use. There are variances of operating modes that companies can employ in international business operations. Some of the modes of operation include exporting and importing merchandise and services, direct and portfolio investments, and collaborative arrangements with other companies. Furthermore, managers that operate within a company’s external environment must possess not only knowledge of business operations ,but also be enlightened about some of the basic social sciences. Therefore, managers within a corporation should be acknowledged as trustees and guardians of the investments made by the shareholders. In addition, the managers have a corporate social responsibility as well as responses to stakeholders. To be acquainted, it was suggested, that managers have been categorized into three types of moral values: immoral, amoral, and moral. Usually, managers carried out varied management styles with the stakeholders. Noteworthy enough, there are certain social responsibilities that come into play in the decision making of managers. Social responsibility can be examined by identifying these major components economic, legal, ethical and discretionary responsibilities. To meet these obligations, communication with external and internal stakeholders ,is vital to the organizations survival. Conflict within companies and within international organizations is one of the main problems in International Business. Also, the difference of opinion in strategies between different management levels in international business also poses a problem. Therefore, if support is inadequate the international business proposal fails. Richard Welford, identified four overall areas that can be used in assessing corporate policies for corporate social responsibility and they are as follows: internal aspects, external aspects, accountability, and citizenship. Integrating corporate responsibility into the company’s strategy can be a challenge for many companies that have never considered the benefits and effects of being a responsible citizen. “Global manufacturing and supply-chain management are important in companies’ international business strategies.” (Edition 569) There are some major issues related to supply chain management that should be mentioned. Some specific issues that have materialized included effective global manufacturing strategy, the role of information technology in global supply-chain management, quality, supplier networks, and inventory management, including the importance of effective transportation networks. “The success of a global manufacturing strategy depends on four key factors: compatibility, configuration, coordination, and control”. (Edition 571) Activities such as coordination and control include everything along the global supply chain from purchasing to warehousing to shipment. When a strong commitment to information technology is in order, the supply chain strategy is most effective. Companies that pursue international sales and marketing also go after global sourcing for the self same reasons. “As noted, quality and safety are other concerns with global sourcing.” (Edition 584) Unfortunately, as a result of the countries producing cheap products they also lack adequate regulations, enforcement, and logistical infrastructure, thus leaving it up to the purchasing companies to ensure quality and safety. References Javalgi, R. G., Granot, E., & Brashear Alejandro, T. G. (2011). Qualitative Methods in International Sales Research: Cross-Cultural Considerations. Journal Of Personal Selling & Sales Management, 31(2), 157-170. Edition, Custom. SKS 5000-Business Strategies for Organizational Effectiveness within the Global Perspective VitalSource eBook for Northcentral University. Pearson Learning Solutions. VitalBook file. Conceptual and Normative Aspects of International Management Endel J. Kolde and Richard E. Hill The Academy of Management Journal Vol.10, No. 2 (Jun., 1967), pp. 1190128 Published by: Academy of Management Article Stable URL:http://www.jstor.org/stable/254631

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