TOTAL QUALITY MANAGEMENT.pptx
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This document discusses quality management concepts in healthcare laboratories. It defines key terms like quality, quality assurance, quality control, total quality management. It explains approaches like continuous quality improvement, quality assessment and sigma metrics that are used to monitor performance and ensure reliable test results. The goal of quality management is to deliver accurate and timely reports to healthcare providers and continuously improve laboratory processes.
TOTAL QUALITY MANAGEMENT.pptx
- 1. sum-total of all the characteristics of a product/service that has a bearing upon the utilization of the product/service to the entire satisfaction of the consumer Conformance to the requirements of users or customers and the satisfaction of their needs and expectations
- 2. 1) Acceptable 2) Accessible 3) Affordable 4) Appropriate
- 3. Total Quality Management (TQM)→ an activity to improve pt. care by having the lab monitor, its work to detect deficiencies & subsequently correct them. Continuous Quality Improvement (CQI) or Performance Improvement (PI)→ to improve the pt. care by placing the emphasis on not to make mistakes in the first place Quality Assurance (QA)→ external activities that ensure positive pt. outcomes. It measures what a lab can do to improve reliability
- 4. TQM also referred to as : total quality control (QC), total quality leadership, continuous quality improvement, quality management science or industrial quality management Quality systems in healthcare organization is evolving • Public & Private pressure to contain costs are now accompanied by pressure for quality improvement (QI) • TQM provides – management philosophy for organizational development & a management process for improvement of quality in all aspects of work
- 5. The Universal principles of TQM are Customer focus Management commitment Training Process capability & control Measurement using quality-improvement tools
- 6. Costs must be understood in the context of quality • Quality = conformance to requirements • “Quality costs” =“Costs of conformance” + “Costs of non conformance
- 7. Quality Costs Costs of Conformance Costs of Nonconformance Prevention Costs Appraisal Costs External failure Costs Internal failure Costs Examples: Training Calibration Maintenance Examples: Inspection Quality control Examples: Scrap Rework Repeat runs Examples: Complaints Service Repeat request Understanding of quality & cost leads to a new perspective of relationship b/n these two concepts: “ Improvement in quality lead to reduction in costs” 10
- 8. Quality improvement occurs when problems are eliminated permanently • Quality problems are primarily management problems because only management has the power to change work process • TQM views the organization as a support structure rather than a command structure • Most immediate processes required for the delivery of services are those of the frontline employees • Senior management’s role is to support the frontline employees & empower them
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- 11. QLPs - include analytical processes & the general policies , practices, and procedures that define how all aspects of the work are done • QC- emphasizes statistical control procedures, but also includes nonstatistical check procedures • QA- concerned primarily with broader measures & monitors of lab performance (turnaround time, specimen identification, patient identification, test utility) • QI- a structured problem solving process to help identify the root cause of a problem & a remedy for that problem • QP- provides the planning steps
- 13. TQM is also considered as a quality system that is implemented to ensure quality • QS- “ set of key quality elements that must be in place for an organization’s work operations to function in a manner to meet the organization’s stated quality objectives”
- 15. The main objective of a laboratory is to provide reliable, timely and accurate test results. This is only possible through - consistent monitoring and evaluation of the laboratory’s performance , implementation and - follow-up of corrective actions for non- conformance to procedure
- 16. • QUALITY ASSESSMENT (EXTR.) QUALITY: A DEGREE OF EXCELLENCE • QUALITY CONTROL (INTER.) + QUALITY ASSURANCE 20
- 17. Internal Quality Control (IQC) – includes personnel, instrumentation, document control, reagent control and corrective action • External Quality Assurance (EQA) – External quality control is important to ensure the laboratory is performing to an external standard
- 18. Quality Control -QC refers to operational techniques that must be included during each assay run to verify that the requirements for Quality are met with • Quality Assurance - QA refers to all those planned and systematic activities to provide confidence that the results given out by the laboratory are correct
- 19. The aim of QC is simply to ensure that the results generated by the test are correct. However quality assurance is concerned with much more: that the right test is carried out on the right specimen and that the right result and right interpretation is delivered to the right person at the right time
- 20. Quality assurance program consists of broad spectrum of practices, plans and procedures that will assure (to be sure and confident) that the quality will be maintained. There are several essential elements of quality assurance program. - Commitment - Facilities and resources - Technical competence - Technical procedures
- 21. Also known as proficiency testing → Quality Assessment is a means to determine the quality of the results generated by the laboratory → Quality Assessment is a challenge to the QA and QC programs → Quality Assessment may be external or internal.
- 22. Right recording and reporting • Right interpretation – Range of normal values • Right turnaround time • Report to right user
- 23. Proper procedure includes: – All data entry results should be verified by a section head or supervisor (when available) and reviewed by management for final interpretation and release of results – In the event that a report has already been sent out and needs correction, a new report is issued with updated report written on it • The old report remains in the patient file – Verbal result reports should be documented, listing the time of the receipt of the report
- 24. Six sigma metrics are being adopted as the universal measure of quality for the quality management. Six sigma goal for process performance shows that error distribution of a measurment procedure should fit within the tolerance specification or quality requirement for that measurment.
- 26. One approach is to measure outcome by inspection. Other is to measure variation and predict process performance.
- 29. Sigma metrics DPMO Percent defects Percentage yield 1 691,462 69% 31% 2 308,538 31% 69% 3 66,807 6.7% 93.3% 4 6,210 0.62% 99.38% 5 233 0.023% 99.977% 6 3.4 0.00034% 99.99966%
- 30. Conversion to sigma metric is done by using standard table available. In health care organization a defect rate of 0.033% (333 DPM) is considered excellent, where error rates from 1% to 5% are often considered acceptable. A 5.0% (50000 DPM) error rate corresponds to 3.15 sigma performance and 1.0% error rate corresponds to 3.85 sigma. Six sigma shows that the goal should be error rate of 0.1% (4.6 sigma) to 0.01% or 100 DPM (5.2 sigma) and ultimately 0.001% (5.8 sigma).
- 31. The application of sigma metrics for assessing analytical performance uses the variable obtained during method validation studies, like accuracy, precision, PPP, NPP, sensitivity, specificity parameters and that available from internal and external quality control processes.
- 32. In the laboratory sigma performance of the method can be determined from imprecision: SD or CV and inaccuracy (bias) observed for a method and quality requirement (allowable total error, TEa) for the test. Sigma metric from 6.0 to 3.0 represents the range from best case to worst case respectively. Methods with sigma performance less than 3 are not considered acceptable for production.
- 33. The practical goal is to achieve a probability of error detection of 0.90. This is easy to accomplish for processes with 5 or 6 sigma performance, it requires a more careful selection and increased qc efforts for processes from 4-5 sigma and very difficult for processes with less than 4 sigma.