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The article by Monty L. Lynn and David P. Osborn describes the experience of implementing the Deming’s quality principles in the quality improvement program conducted by the management of Brazosport Memorial Hospital. The article can be divided into two main parts. The first part gives an overview of the Deming’s quality principles, including the history of their creation and recognition. It also presents a brief summary of the central themes and philosophies behind the approach. Finally, it evaluates the relevance of the principles, notes on its originality and structure, and compares them to their closest competitors, stressing its differences.
The second part gives a detailed description of the quality improvement process (QIP) implemented in the hospital, emphasizing the fundamental orientation towards the changes in managerial style rather than a standalone program, and outlining the three major components of the process. The first, quality orientation, was achieved through the formation of the quality improvement council and generation of the policies and definitions of quality.
Besides, the handouts with quality guidelines were used to promote a new approach among employees, who were also encouraged (but not pressured) to read the relevant literature. The second component, continuous process improvement, was the closest to the source material. It utilized the Deming’s approach of locating the opportunities for improvement, outlining the possible drawbacks, and eliminating the obstacles.
According to the authors, the process was applied throughout the hospital departments and was universally applicable. The process also included gathering feedback from the patients via a survey on a regular basis. The third component, total employee involvement, was reached by assembling quality-improvement teams aimed at achieving certain objectives. The article then describes the specifics of the staff education process. Finally, a detailed list of obstacles faced throughout the process is included, and some of the possible future challenges are projected.
Key Learning Points
The relevance of the quality improvement programs for the healthcare industry; the suitability and applicability of the Deming’s principles to the operations segment of health care; the limitations and challenges created by the inherent characteristics of Deming’s principles;
Relevant Statements to the Session
The quality improvement programs have long been established as a crucial component in the process of business development. Some of the approaches, such as Deming’s quality principles, are among the most recognized representatives and have been extensively used throughout the business world, reaching far beyond their intended scope. The article illustrates one such case, where the quality principles have been used as a basis for the management style used for QIP by the healthcare provider. In addition to the benefits extensively covered in the previous sessions, the article illustrates the limitations and drawbacks of such an approach, further expanding our scope.
The authors’ central implication is the applicability of the Deming’s quality principles to the management of the healthcare field. While very little specifics are given, the overall tone and the generalized claims made in the article suggest that the Brazosport Memorial Hospital administration is highly satisfied with the improvements in the outcomes and patient feedback and attribute it to the QIP in question. While there is little reason to doubt the latter assertion, the initial assumption needs to be approached critically before any specific conclusions can be reached.
First, the framework selected by the management was initially conceived for industrial application, which was promptly taken into account by the managers and reported in the article. The authors also stress that the implementation of the industry-oriented quality improvement techniques is becoming increasingly popular in the health care. However, at the time of the article’s publication, 1991, the area of quality improvement was still far from maturity, and the field lacked proper assessment instruments and established criteria to obtain hard data on the success of any given program.
Currently, a growing number of scholars tend to view the industrial techniques only partially suitable for the fields such as healthcare which prioritize the patient outcomes and deal with much more complex criteria of quality. While the authors recognize this limitation, which can be seen from their claim that the implemented style was not fully consistent with the initial setup suggested by Deming and had necessary amendments, the described QIP still retains some of the drawbacks inherent in the principles not crafted for the healthcare.
The first issue is the concept of quality used by most of the industrial quality improvement programs. In most cases, especially in the case when the company is involved in production, the quality can be directly assessed, recorded, and documented. Most likely, the obtained data is also suitable for further statistical analysis, which is one of the approaches preferred by Deming. In other words, Deming’s principles are best implemented when the data is quantitative and can be properly processed to produce meaningful results.
On the other hand, the fields which deal with services often have difficulties assessing their quality. Health care is among the most prominent examples of such case. While certain outcomes are essentially binary in nature, such as the mortality rates, they comprise only a fraction of the total factors that should be taken into account. To further complicate matters, most of the assessed factors consist of several aspects, such as the state of the recovered patient, the possible complications, the initial accessibility of the service, and the financial side, among many others, each of which must be assessed separately.
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As this can also be said about most of the other industries, it is reasonable to expect that the instrumentation necessary for the complete assessment is available. Still, the field of healthcare is arguably among the ones most dependent on the human factor and the customer’s perceptions, so sufficient degree of amendments is required to introduce the Deming’s principles as a management style.
Another concern is the focus on the customer feedback. The article makes it clear that the patient feedback is an important element of the QIP, as it involves the survey conducted twice a year to identify the areas which display the most signs of inconsistency and require change, as well as monitor the change of perspective among patients in the areas where the change has already been implemented. This is evident given the definition of quality developed by the council: the quality of the health care services is determined primarily by the expectations of the patients and community, among other stakeholders.
Such approach unintuitively excludes the clinical aspect from the list but allows for a more focused evaluation. It is worth mentioning that while different industrial quality improvement programs necessarily include the customer satisfaction into the evaluation process, the level of attention they pay to it varies, and may not be suitable for the industries that focus on services such as healthcare. Admittedly, Deming’s framework prioritizes it, which was probably the reason for making it a method of choice.
This assertion is further confirmed by the fact that this stage of assessment is noticeably more detailed in the article than any other strategy. Besides, the survey is an instrument with established credibility, developed by the reputable source, and thus is suitable for producing standardized results. Thus, while this particular innovation is laudable, it is still unclear to what extent such move can be attributed to the utilization of the Deming’s principles.
To conclude, the change in directions undertaken by the management of the hospital should not be underestimated. However, an appropriate question to ask is whether the Deming’s principles were responsible for the success. In essence, the principle was only partially applicable to the work done by the council and has taken a form of the guidelines for the managerial style rather than a set of techniques.
This is confirmed by the authors, who openly state that the Deming’s principles are unsuitable to the clinical aspect of quality, and can be extrapolated from the lack of specifics given in the example with the incomplete medical records. Both the training of the staff involved in the process and the organizational techniques demonstrated by the management do not require a specific style or the reliance on the certain doctrine. Coupled with the already established questionable suitability of the Deming’s approach to the healthcare field, it becomes clear that it only can be used with serious modifications.
In other words, while the article confirms the benefits of the Deming’s principles’ application as a kickstarting platform to initiate the change and take the necessary direction, it also shows that it has only limited applicability later in the process, once the most vital shortcomings, such as incomplete medical records, were addressed. The experience gained by the Brazosport Memorial Hospital team is valuable, but mostly as an illustration on what to address initially and which elements of the Deming’s approach should be incorporated into the dedicated healthcare QIPs once such developments take place.
Despite the questions raised during the critical analysis, the article still offers information that can be used in a real business case. Primarily, the case study in question confirms the flexibility of the Deming’s approach. The principles have extensively been used in the industrial sector, and a sufficient number of cases confirms the benefits of using it. On the other hand, its adaptation by the service organizations remains comparatively limited. The steps taken by the management can serve as guidelines for further cases.
For instance, the hotel business, which is similarly focused on the delivery of services, may benefit from the similar strategy. While it is sufficiently different from the healthcare establishment described in the article, the differences actually create the advantages for the former. The main difference is the focus of the hotel industry on the customer satisfaction and the operational aspect, in contrast to the presence of clinical segment, which could not be managed by the Deming’s principles.
As a result, the possibility arises to create a unified approach for the whole business rather than introduce separate strategies and styles for each department. This already eliminates some of the challenges mentioned in the original article, such as the difficulty of introducing the information from the segment which does not operate under the said approach (and, more importantly, does not produce data which can be easily and seamlessly incorporated into the existing analysis) into the final result.
The hotel business can also utilize the quality improvement teams used in the hospital, especially considering the fact that the hotel setting has fewer possible complications, such as the complexity of the performed actions. In other words, while the nurses and physicians are predominantly engaged in clinical tasks, the hotel staff is focused on the operational side. As a result, it is expected that the complexities of team management will be comparatively minor and will not interfere with the organization’s function or require additional managerial effort, as was the case in the hospital. Another notable practical implication is the possibility to use the list of the challenges, which is concise and detailed, as a guide in case a similar approach will be undertaken by another healthcare provider.
Several important lessons can be drawn from the critical analysis. First, the introduction of the quality improvement process in the area with little previous experience can yield noticeable progress. However, it may also pose several challenges, some of which may become a serious drawback in the long run, such as the difficulties in team management and the unexpected amount of resources and time required to implement change.
Second, the lack of appropriate evaluation tools may, in fact, result in misattributing the success to a specific method rather than to a more generalized effort directed at overseeing and managing a specific problem, as was derived from the analysis of the improvement with the incomplete health records example. Third, the amount of change required by the field of implementation suggests the benefits of the cumulative approach, where developing a new managerial style can be more efficient than relying on a set of established and trustworthy instructions.