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Quality Frameworks in King Faisal Specialist Hospital & Research Center Essay

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Updated: Mar 17th, 2022

Executive Summary

This report entails the adoption of quality frameworks in KFSH&RC hospital operating in Saudi Arabia. The key quality frameworks considered in this case include Continuous Quality Improvement (CQI), Total Quality Management (TQM), and ISO 9001 protocols. Each framework is reviewed relative to its relationship to the health facility’s aims and objectives. This is achieved through assessing the key aspects of each framework and its effectiveness in the hospital settings. The barriers to the implementation of these frameworks are also considered besides; the report gives the most probable recommendations in dealing with these barriers. These frameworks are appropriate in this case because they are the most popular in almost all industries. Moreover, implementation of these frameworks in the hospital will enable the management to develop excellent operating protocols and therefore improve total quality in the whole organization. However, lack of employee comprehensiveness and active participation can hinder the process of implementing the frameworks. Therefore, it is imperative that the hospital develops an effective communication strategy to solve these problems.


The competitive environment characterizing most business and healthcare industries has forced most organizations to resort to implementation of the quality control standards in order to stand the test of time. This is achievable through adopting appropriate quality management strategies, which will ensure that the organizations’ performance reflects its continuous improvement. For most organizations, quality management incorporates the concepts of six sigma, Lean Thinking (LT), and balanced scorecard, which form the basis of a number of quality frameworks.

In this report, three major quality frameworks, which are used in King Faisal Specialist Hospital & Research Center (KFSH&RC) are analyzed relative to their effectiveness in the hospital’s quality management and improvement strategies. The frameworks analyzed in this report include Total Quality Management (TQM), ISO 9001, and Continuous Quality improvement (CQI).

Description of the selected Healthcare Facility: King Faisal Specialist Hospital & Research Center (KFSH&RC)

KFSH&RC is a healthcare organization situated in Riyadh, Saudi Arabia. It comprises of 844 bed spaces and employs over 400 consultants from different countries. The hospital’s annual patient medical appointments are approximately 32,000 patients plus an additional 500,000 outpatient appointments annually. It provides tertiary services to the local citizens, teaching, and research services. In this way, the hospital enables the Saudi people to save on the cost of travelling abroad to seek medical attention besides providing the best quality of health care services (IHR 2004, p. 1 of 3).

Additionally, in order to maintain the best quality in service delivery and continuous improvement, the organization has implemented the ISO 9001 and TQM/CQI models. The implementation of these frameworks is reinforced by the Quality Resource Management Department, which was established in 2001. In addition, KFSH&RC is the first healthcare organization in Saudi Arabia to receive the ISO 9000 certification in 2002 (IHR 2004, p. 1 of 3).

Explanation of the Quality Frameworks

Total Quality Management and Continuous Quality Improvement (TQM/CQI)

TQM/CQI entails a continuous process whereby all employees of an organization are incorporated into the process of assessing the needs and experiences of the organization’s customers (Curry & Magd 2003, p. 244). The information obtained from such assessments is employed in restructuring the organization’s operations to continuously meet the customer needs. The TQM/CQI model is based on trust, communication, ethics, teamwork, integrity, and training. Trust, integrity, and ethics are required in the successful implementation of the model. On the other hand, communication and teamwork aid in improving quality in the whole organization. Moreover, training and comprehensiveness of the elements of the model adds to its successful implementation (Padhi 2009, p. 23).

Implementation of TQM seeks to change the perception of quality in the whole organization. In this way, TQM entails a change in organizational culture in terms of management practices and processes influencing quality to allow for continuous improvement and the active participation of all staff members in the process of quality improvement (Decker 2002, p. 226). At KFSH&RC, the TQM/CQI model forms the basis of the organization’s success because it forms and reinforces the aims and objectives of the hospital. In addition, the organization strives to ensure that quality forms the foundation of professional healthcare service provision and that continuous improvement is part of the hospital’s excellence in service delivery.

ISO 9001 standards

According to the ISO 9001:2000 standards, training in any organization is supposed to be provided on the basis of competency requirements in carrying out certain tasks in the organizations (Beholz et al. 2003, p. 167). This differs from the 1994 standards, which do not recognize the importance of competency needs in training (Frate 2004). Through this standard, the management of any organization ensures that its customers are entitled to certain quality standards on the products and services offered.

Having implemented ISO 9001:2000, KFSH&RC offers services of the required standard of quality to its customers. Through the ISO 9001:2000 framework, all staff members of the organization are required to treat all patients with the same standards of quality as provided for by the ISO 9001:2000 standard. (Le et al. 2009, 646).

The barriers to and facilitators of the implementation of quality improvement

The ISO 9001 has many disadvantages in terms of the time, paperwork, and money that go into registration. However, the imperative need for training in many organizations calls for its implementation. Moreover, in the ISO 9001:2000 standard, it is unclear on which group of the organization’s staff members performs functions that can affect quality (Zabada et al. 2008, p. 57). Additionally, it is not the requirement of ISO standards that the competency requirements be documented however; common sense demands that these needs be documented in order to allow for assessment of the effectiveness in communication of the competencies within the organization.

Based on the staff’s propositions, the concept of TQM/CQI is appropriate in terms of ensuring that there is continuous improvement within the organization. However, the number of staff members sharing the same thoughts is very low each month (Badrick & Preston 2001, p. 166). Additionally, the staff members suggest that there is no instantaneous improvement observable from these frameworks. Therefore, the model enjoys the support of very few staff members. In fact, according to Amar & Zain (2002, p. 367), many organizations are experiencing very minimal staff involvement in the implementation of the TQM/CQI model. Therefore, the model is seen as the responsibility of the top management.

Effectiveness of implementing quality frameworks

Having implemented the ISO 9001 and TQM/CQI frameworks, KFSH&CR is now recognized as a specialist hospital and it has been awarded for this achievement by the Joint Commission International Accreditation (JCIA). This is because; the hospital has been successful in safeguarding the safety of the patients through accrediting and certifying most of its services (Viswanathan & Salmon 2000, p. 1117). Moreover, the hospital provides educational and advisory services to its customers (IHR 2004, p. 2 of 3).

The ISO 9001 standard has many advantages. Firstly, it enables organizations to run their operations effectively and smoothly. Secondly, it guarantees customer safety, retention, and satisfaction and reduces audits. Thirdly, it uplifts the motivation, morale, and awareness among the employees. Finally, the model increases productivity among the staff members (Yang 2003). Implementation of ISO 9001 can also minimize uncertainty, which is rampant in many healthcare facilities (Trevor 2002). By ensuring that nurses and other hospital workers are aware of the protocols and the job descriptions, the model enables the workers to perform their duties correctly. Moreover, specific responsibilities and work instructions are clearly defined thereby reducing confusion amidst staff members (Brown et al. 2002, pp. 30-42).

The ultimate importance of implementing the TQM/CQI model is that it improves service delivery and the organization’s operations. This model offers a number of tools and techniques, which can be used by different organizations to improve their operations. Besides, recent studies indicate that the TQM/CQI concept has gained popularity in many organizations (Le et al. 2009, p. 662). The main advantage of this model is that it offers flexibility in its implementation in that two different organizations can implement it in two different ways that fit into the organizations’ requirements. The implementation of the TQM/CQI and ISO 9001 models can ensure that KFSH&RC hospital achieves continuous improvement and quality in professional performance. Moreover, this will ensure that the hospital responds to customer and employee needs through increased staff commitment, involvement and active participation in the organization’s operations.

Solutions to Overcome the barriers

In order to achieve continuous improvement and quality, communication and training should be part of the implementation process for the three frameworks. This is achievable through the hospital developing strategies for staff training using the ISO 9001 document. This entails identification of the competency gaps followed by implementation of the on-the-job training activities. Planning for the training entails definition of time-frames, the training objectives and stating the measures to be taken.

In order to implement the principles of TQM/CQI effectively, communication between the management and the junior staff is imperative. Communication is also important in training as discussed in the ISO 9001 protocols (Birkenstock 2009). In this case, communication entails the top management explaining the importance of continuous improvement and quality management to the junior staff. This should also involve motivating the staff members through reporting the achievements of the TQM/CQI program through the Quality management department. However, it is worth noting that communication already exists in the TQM/CQI programs and it is upon the top management to employ it properly in resolving the problems encountered in the hospital settings.

Conclusions and Recommendations

The report analyzes the key aspects of ISO 9001 and TQM/CQI models in KFSH&RC hospital and the effectiveness of implementing these frameworks in the hospital. Moreover, the report identifies some barriers that hinder the implementation of these frameworks besides providing probable solutions to the barriers. From the discussions above, ISO 9001 entails standardization of quality in the hospital setting while TQM/CQI entails improvement of quality and the organization’s operations. The ISO 9001 protocols have helped the hospital to define specific responsibilities and job assignments besides categorizing them in the documenting system. On the other hand, implementing the TQM/CQI model enables KFSH&CR hospital to improve its operations and quality in all departments.

The general barriers that hinder the implementation of the frameworks include the less active involvement of the employees and the tedious paperwork involved in the implementation process. However, development of clear communication channels ensures that all staff members use the TQM/CQI and ISO 9001 models effectively. Overall, effective implementation of TQM/CQI and ISO 9001 frameworks in KFSH&RC will enable the hospital to experience continuous improvement and successful quality management.

Reference List

Amar, K & Zain, ZM 2002, ‘Barriers to implementing TQM in Indonesian manufacturing organizations’, The TQM Magazine, vol. 14, no. 6, pp. 367-372.

Badrick, T & Preston, A 2001, ‘Influences on the implementation of TQM in health care organizations: professional bureaucracies, ownership and complexity’, Aust Health Rev., vol. 24, no. 1, pp. 166-175.

Birkenstock, J 2009, , Web.

Brown, JC, Dick, G & Gallimore, K 2002, ‘Does ISO 9000 accreditation make a profound difference to the way service quality is perceived and measured?’, Managing service quality, vol. 12, no. 1, pp. 30-42.

Beholz, S, Koch, W & Konertz, W 2003, ‘Quality management system of a University Cardiac Surgery Department According to DIN EN ISO 9001:2000’, Thorac Cardiovasc Surg, vol. 51, no. 3, pp. 167-173.

Curry, A & Magd, H 2003, ‘ISO 9000 and TQM: are they complementary or contradictory to each other?’, The TQM magazine, vol. 15, no. 4, pp. 244-256.

Decker, MD 2002, ‘The application of continuity quality improvement (CQI) to Healthcare’, Infection Control and Hospital Epidemiology, vol. 13, no. 4, pp. 226-229.

Frate, C 2004, History of QMS, Web.

IHR 2004, King Faisal Specialist Hospital and Research Center, International Hospital Recruitment, Inc., Canada, Web.

Le, PKC, To, WM and Yo, TW 2009, ‘The implementation and performance outcome of ISO 9000 in service organization’, International Journal of Quality and Reliability Management, vol. 26, no. 7, pp. 646-662, (online Emerald Full text).

Padhi, N 2009, The eight elements of TQM, Web.

Trevor, L 2002, Understanding ISO 9000: user benefits and drawbacks, Web.

Viswanathan, HN & Salmon, WJ 2000, ‘Accrediting organizations and Quality Improvement’, The American Journal of Managed Care, vol. 6, no. 10, pp. 1117-1130.

Yang, CC 2003, ‘The establishment of YQM system for the health care industry’, The TQM magazine, vol. 15, no. 2, pp. 93-98.

Zabada, C, Rivers, PA, Munchus, G 2008, ‘Obstacles to the application of total quality management in health-care organizations’, Total Quality Management & Business Excellence, vol. 9, no. 1, pp. 57-66.


KFSH&RC reward from 2001-2008

  • Endoscopic Ultrasound Service (EUS) was developed (2001)
  • Establishment of Department of Medical Genetics (2001)
  • Comprehensive Geriatric Assessment Clinic was initiated (2001)
  • Establishment of Comprehensive Movement Disorders Program (CMDP) with a facility for stereotactic surgery for Parkinson’s Disease (2001)
  • Stereotactic Radiotherapy Program (2001)
  • Genetically modified food testing introduced (2002)
  • Opening of the Sleep Medicine Unit (2002)
  • Expansion of the Day Procedure Center to accommodate over 1,500 patients per month (2002
  • Gynecology/Minimally Invasive Surgery Clinic was opened (2002)
  • Hemophilia Program was established (2002)
  • Section of Colorectal Surgery was established (2002)
  • Thermal balloon endometrial ablations were initiated (2002)
  • King Faisal Specialist Hospital and Research Center becomes a corporation Celebration of performance of 1,000 allogenic bone marrow transplantations (2002)
  • Establishment of Lung Transplant Unit (2003)
  • Establishment of King Faisal Cancer Center (2003)
  • Establishment of the Department of Liver Transplantation and Hepatobilliary-Pancreatic Surgery (2003)
  • Establishment of a Clinical Research Center (2003)
  • Establishment of Breast Cancer Program (2004)
  • KFSH&RC has won the Sheikh Hamdan Bin Rashed Al Maktoum Award for Medical Sciences in the category of “Best Medical Services in the Arab World”. (2004)
  • Establishment of Adult Alternate Donor Stem Cell Transplantation Program (2004)
  • Re-accredited by JCIA for 3 years. (2005)
  • Expanded the use of SMS service to remind patients of their appointments, re.ll medication, vaccinations, update bio-data, and to advertise for blood donation. (2005)
  • The first matched unrelated donor hematopoietic stem cell transplantation (MUD) was performed. (2005)
  • Started Surgical (MAZE) ablation for the treatment of chronic atrial fibrillation. (2005)
  • KFSH&RC was recognized by The Myelodysplastic Syndromes Foundation as a Regional Center for Excellence for Myelodysplastic Syndrome (2005)
  • PET/CT Scan was commissioned. (2005)
  • KFSH&RC was designated as a Cooperative-Telemedicine Center by World Health Organization. (2005
  • Accredited by the Royal College of Pathologists of Australia (RCPA) for residency in Pathology. (2005
  • ISO/IEC 17025 accreditation received (Toxicology Section) in testing of non-clinical sample. (2005
  • Established Clinical Quality Indicators for quality improvement. (2005)
  • Utilized established Key Performance Indicators through use of Scorecards in management decision-making. (2005)
  • Utilized clinical core competency programs to manage and allocate resources. (2005)
  • PATIENT SAFETY (2006):
    • Implemented the Anesthesia PYXIS machine in the Operating Room. It streamlines management of medications and supplies for anesthesia, and securely stores anesthesia products at the
      point of care.
    • Number of reported medication dispensing errors reduced by 35%.
    • Participated in 100,000 Lives Campaign, which includes the following projects: Rapid Response Team–this has resulted in a 54% decrease in codes.
      • Central Line Infections
      • Surgical Site Infections.
      • Ventilator Associated Pneumoni
      • Adverse Drug Reactions
  • QUALITY OF CARE (2006):
    • Implemented CBAY-FLO, a web-based transcription product. This has expedited the completion of patients’ medical records, making critical information available in a timely fashion.
    • Expanded installation of Q-Matic Calling System in the clinics which resulted in increased patient satisfaction.
    • Created a one-stop-shopping for patients in clinics.Expandedthe SMS appointment reminder system.
  • ACCESS (2006):
    • Throughthe Health Outreach Services, 2,058 KFSH&RC patients were seen, and 358laparoscopic and othersurgical procedures were performed in the region.
    • 434 organ transplantations were performed.
  • EDUCATION (2006):
    • Accreditation of all Nursing activities by the American Academy of Continuing Medical Education.
    • Signing of an agreement for educational affiliation andcooperation with Al Faisal University Medical College.
  • KFCC opened four disease specifc database/registries for rectalcancer, Hodgkin’s, Non-Hodgkin’s and lymphomaand five clinical protocols established inepithelial ovarian cancer, breast
    cancer,renalcellcarcinoma, and myeloidleukemia. (2007)
  • KFCC launched the Intensity Modulated Radiation Therapy (IMRT) Program. (2007)
  • KFHI’s Heart Transplant Program performed 12 heart transplantsin 2007 with no deaths.The number of heart transplants performed in the last twoyears and heart transplant outcome results have become the most positive continuing story in the Kingdom about the programs offered at KFHI. (2007)
  • KFHI continued to perform the most complicated and repeat congenital heart surgeries in the Middle East making it one of the top 10congenital heart centers in the world. (2007)
  • Medical Genetics’Targeted Genetic Disease Prevention Program (TGDPP) – the frsttargeted prevention programto be launched inthe Kingdom of Saudi Arabia. (2007)
  • Establishment of the Cardiovascular Genetics Program –the frst program to address genetics of cardiovascular diseases. (2007)
  • Thesection of Neurosurgery wasrecognized bythe World Federation of Neurosurgery as a training center for Interventional Skull Base Surgery. (2007)
  • The section of Pediatric Neurology established the ADHD (Attention Deficit Hyperactivity Disorders) National Program in collaboration with CHADD (Child & Adult with ADHD). (2007)
  • Established the Autism Program. (2007)
  • Development of the Epilepsy Registry to a national registry. (2007)
  • The Department of Orthopedic Surgery established the first Bone Bank in the Kingdom to replace resected bones following oncology surgery. (2007)
  • Implementation of the Navigation System for joint replacement and spinal surgery. (2007)
  • Council of Ministers issued a Royal Order for the amalgamation of King Faisal Specialist Hospital-
    Jeddah with King Faisal Specialist Hospital & Research Centre-Riyadh (General Organization)
    in May 2008.
  • Clinical Services was successfully re-accredited by the Joint Commission International Accreditation during the on-site survey in March 2008.
  • Inaugural publication of the KFSH&RC Hematology/Oncology and Stem Cell Therapy Journal in January 2008.
  • KFCC awarded membership in the Canadian Bone Marrow Transplantation Group (CBMTG). (2008)
  • KFCC achieved institutional membership and collaborative studies with the Southwest Oncology Group (SWOG), American College of Radiology Imaging Network (ACRIN). (2008)
  • KFCC established the Eastern Mediterranean Blood & Marrow Transplantation Group (EMBMT). (2008)
  • Established the first National Bone Bank that will serve the Ministry of Health and other hospitals. (2008)
  • Founding and developing the Fetal Diagnosis and Therapy Program which began February 2008.
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