Ideal Approach to Quality

All the approaches to quality management such as quality circles, six sigma, lean thinking, TQM, ISO certification or NABH/JCI accreditation, have certain plus point and have provided their merit convincingly in many organisations all over the world. However, their suitability in hospital scenarios depends on many factors.

Six sigma is a problem oriented process improvement approach aimed at reduction of variations/non-conformities. It is a complicated data driven mathematical approach and has very limited applications in the hospital setup.

Lean Thinking , too, is a process improvement approach. However it is through elimination of waste of resources. It is comparatively simpler and can be applied beneficially in any area of the hospital where there is a problem of wastage of resources. However, by itself it may not be adequate as a system for quality management and continuous quality improvement in an organization.

ISO System is a system of certification that the organization has implemented some system of quality management and continuous quality improvement. It is an approach aimed-at process improvement and has a comprehensive structured system of documenting the policies and procedures. This system, however has major shortcomings in that it does not prescribe any quality standards of its own and does not certify the quality of outcome, i.e. the services provided by the organization.

TQM is a widely accepted system of quality management and continuous improvement. It is a long term initiative aimed at defect prevention and continuous process Improvement. It is a system driven   by the needs of customers. It is not just about improving the quality, it is about customer satisfaction and can be implemented in hospitals. Many organizations seriously aiming at quality improvement are adopting this approach even though it does not have the advantage of any external   certification/accreditation.

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NABH (orJCI) accreditation system has a lot of advantages over other approaches, It is a patient focused approach aimed at improvement in  ‘outcome through improvement in process of delivery of care. It has laid   down certain specified quality standards and certifies the quality of outcome

On the basis of compliance of the prescribed standards (related to quality of process and evaluation of performance). Documentation of policies and procedures and their regular review is a mandatory requirement, though there is no structured format for documentation as in ISO System. Initial efforts and expenditure involved are discouraging for some organizations. However, NABH accreditation is, by far, the best approach with promise of substantial benefits in the long run.

An ideal approach for a hospital may be to adopt the concepts of TQM as a system of quality management, and then achieve external recognition through NABH accreditation.