Note: This file was downloaded from the Montgomery County (Maryland) Public Library electronic bulletin board and is presented as received. ----------------------------------------------------Business Index & ASAP------ AUTHOR(s): Feigenbaum, Armand V. TITLE(s): TQM: health care can learn from other fields. (total quality management) Summary: Understanding and implementing total quality management programs in the health care sector is one of the most important issues in the industry. Medical care managers need to realize that quality is the fundamental force shaping the US health care sector. The US medical care industry needs to emphasize six primary areas, from education to research, to provide quality medical care service to all patients. Hospitals p56(1) Nov 20 1992 v66 n22 To understand why quality must be the fundamental way of managing health care, we must examine the role of quality in society today. In 1992, according to a General Systems study, nine out of 10 American consumers and industrial companies define their quality expectations in terms of total quality management. Only three or four out of 10 consumers and companies bought and thought this way 10 years ago, the same study found. This upward explosion of quality expectations is one of the biggest social and economic changes in modern American history. Health care progress. Among America's health care institutions, there are enormous disparities in understanding these massive new quality expectations. The reality is that some policymakers' eyes still glaze over whenever quality comes up. This is because quality is still often viewed as a technical issue, rather than as a fundamental force shaping the evolution of American health care in the 1990s-and as a strategic foundation for how service providers must manage in today's environment. Health care quality leaders, like those in other fields, stand out from the quality followers in three ways: they accept upwardly mobile quality expectations as demands to be faced directly; they work on an organizationwide basis rather than incrementally; and they institutionalize their quality leadership by implementing service-driven quality and teamwork processes everyone understands, believes in and is part of. There is an important dimension in quality leadership that I call "the invisible quality of the service." It is driven by how people working in hospitals think and act and decide about quality. This is the swing force in achieving service quality; it is in the final analysis the total quality discipline of the organization, and reflects team members' knowledge, skills and attitudes. What quality leaders share. In terms of quality, the role of senior managers and professional leaders in the 1990s is far more important and far more performance-driven than it was in the '80s. It requires the personal knowhow to develop the organization's quality playbook and to be its quarterback on the field. This means recognizing the characteristics of the best and most successful total-quality organizations, and understanding how to transform his or her own organization. There are several characteristics these corporations have in common: * A rigorous commitment to always produce important service results. * Emphasis on achieving the quality improvement goals required to assure number one service leadership. * Superior utilization and empowerment of human resources at all levels. TQM total quality management--is a basic part of the job of every member of the organization, not just some special projects from time to time. * Emphasis on innovative quality management approaches that get better results first and continue paying off over a long period of years. This is vastly different from approaching quality as a series of loosely strung together anecdotes, as has too often been the case. There is not yet full recognition in the American service provider community that the quality process must go far deeper than a group of motivational initiatives and technical projects. * Recognition that a service receiver who is happy with you means a six or seven times greater likelihood of genuine service satisfaction than a receiver who is merely accepting what you've done for him or her. Experience makes it very clear that quality leadership in the 1990s isn't merely measured in terms of quality defects--zero or otherwise. It's measured in terms of the total service receiver perception of quality. * Emphasis that what you measure right you manage right, and that the quality of measurement is the key to quality leadership today. Six points to progress. There are six primary areas we must emphasize in America to implement the kind of investment needed to make progress in these quality directions: 1. A national imperative must be the recognition and development of a strong and effective mainstream quality process in health care and its integration throughout the health care system. 2. As part of this, we need to provide education on quality from grade school through the university, and teach quality in business and government. 3. Quality education should not be approached through a single quality "department" alone nor as a program of quality training courses, but instead recognized as a fundamental body of knowledge to be taught throughout health care. 4. Research in quality is one of the major keys to the growth of attention and understanding of quality throughout health care. 5. The quality process result we urgently need will come about only through the visible leadership and commitment of health care institutions themselves, particularly through personal leadership at the highest levels. 6. The essence of this initiative is nothing less than an unabashed emphasis on the pursuit of excellence at all levels. That's the drumbeat to which all service providers will be marching in this decade. Feigenbaum is founding chairman and current chairman of the International Academy for Quality Control, and a past president of the American Society for Quality Control. He is the originator of the concept of total quality control (TQC).