Quality management in hospitals is crucial to achieving better patient outcomes. In neonatal and pediatric intensive care, high-quality services can also help to save patients’ lives. Quality, costs, and deliverables are the key indicators of performance that can be applied in this environment. Managers have a unique role in Gemba since they identify problems in practice, analyze their causes, and develop solutions to improve performance indicators. In the present case, the concerns cover each aspect of the workflow, including materials, machines, manpower, environment, measurement, and method. Hence, it is essential to use total quality and total flow management techniques to improve performance in the XYZ Hospital in Abu Dhabi.
Materials are among the primary sources of costs in healthcare settings. Materials used in neonatal and intensive care units may include sheets, napkins, paper towels, hygiene products, syringes, wraps, medications, and others. The quality of materials has a significant effect on the services provided both from health professionals and from patients’ viewpoints. For instance, using low-quality sheets may cause rashes in neonatal patients, whereas low-quality paper products are likely to break easily and make it more challenging to maintain a sanitary environment. Additionally, generic medications often have more side effects than their more expensive alternatives, leading to patient discomfort and prolonging the recovery time. Therefore, it is crucial to establish a balance between the quality and cost of materials used by staff in everyday settings.
To identify problems leading to excessive costs and poor quality, the head of quality needs to assess the situation using the Gemba Walk. This means that they should perform observations on the hospital floor to determine what materials are used in what quantities during which processes. Then, the materials should be assessed for quality and price, and alternatives should be considered. For example, if it is possible to switch to cheaper sheets while maintaining or improving quality, it should be done to reduce the costs.
Supply chains should also be revisited to determine if the current suppliers offer the best products at the lowest prices. To do that, it is necessary to find other healthcare materials suppliers in the area and compare the costs of different materials used by doctors, nurses, and other staff. If the hospital currently has several suppliers for similar materials, the quality manager should also determine whether it would be possible to switch to a single supplier. This would help to manage inventory more effectively and decrease the costs through quantity discounts.
Furthermore, the costs of materials can be managed using a Just-In-Time approach to inventory control and supply chain management. Just-In-Time (JIT) is often used in manufacturing as a production system that makes products through the demand flow (Goetsch and Davis 402). With regards to inventory management, JIT means ordering materials from suppliers when they are needed rather than using regular, scheduled deliveries. This helps to reduce waste in materials and ensure that they are always available when needed. To implement this system, it is essential to establish inventory monitoring and place orders with suppliers when certain materials run low. Hence, JIT is relatively easy to implement and effective in terms of cost-saving.
Lastly, as part of initial observations in the Gemba, it is also critical for the quality manager to identify any excessive use of materials. These observations are in line with the Sort principle of the 5S approach used in TQM (Goetsch and Davis 278). According to this principle, managers need to sort useful from useless, thus determining excessive use or misuse of materials and other resources (Goetsch and Davis 278). If one nurse can use two wipes to clean up after a patient, and another nurse uses more than ten wipes in the same situation, this indicates that materials are used ineffectively. Instances of overuse should be noted, and education should be provided to staff on avoiding excessive materials use.
Today, hospitals are staffed with a variety of machines that are used in the diagnosis and treatment of patients. Some examples of machines are MRI and CT scanners, X-rays, and vitals monitors. Most of these machines are expensive, and diagnostic devices also entail additional costs for each procedure. Identifying problems in machines and their use can help to lower the costs and enhance deliverables.
As in the case with materials, the quality manager needs to understand what machines are used, when, and how. If there are any old or malfunctioning machines on the hospital floor, they can threaten the quality of services and deliverables and should be fixed or replaced despite the costs. If any new devices need to be bought to facilitate service delivery, quality and price balance should be considered in purchase decisions.
The Total Flow Management system can also be applied to machine use to minimize overuse and promote efficiency. To identify potential overuse, it would be useful to map out the flow of processes where specific machines are used and compare it to hospital data on machine use. For example, if a process flow for treating pneumonia includes one X-ray scan, but a particular patient had two within a short period, this indicates overuse. To prevent such cases in the future, it would be necessary to perform root cause analysis for individual overuse cases to determine what causes the excessive use of machines. In the example provided, it is possible that the quality of the first scan was inadequate or that there was an incident of miscommunication, and a doctor did not know about the first X-ray scan. Issues that contribute to overuse, such as poor communication or low scan quality, should then be reviewed and addressed appropriately through staff training or equipment quality improvement.
Manpower relates to all three performance indicators: quality, cost, and deliverables. The quality of services provided and patient outcomes largely depend on the competence and activities of the medical staff. Additionally, staff expenses constitute a significant share of costs in any hospital. To enhance the use of manpower in the XYZ Hospital in Abu Dhabi, the quality manager should analyze the current situation, identify problems, and develop solutions.
First of all, it is vital to analyze the staff composition and roles to determine whether there is an ineffective use of staff. This can help to ensure that every member of the team is useful (Goetsch and Davis 278). For instance, if there are too many nurses and not enough doctors or vice versa, this could decrease the quality of services provided. Doctors and nurses have distinctive roles, and thus it is necessary to achieve a balance. In addition, other staff, including cleaners, pharmacists, and lab technicians, is also responsible for ensuring high service quality. To analyze the use of manpower in the XYZ Hospital, the quality manager should perform observations in the Gemba. The Gemba Walk can help to identify if individual staff members are slacking or overworked, thus causing problems in service delivery. Excess staff members could be changed to part-time workers or let go if their functions do not affect service quality and deliverables. This would help to identify the sources of high costs and address the issue.
Additionally, it is necessary to review the qualifications of each staff member to determine if they contribute to quality and deliverables. For instance, it is often better for hospitals to have three highly qualified and competent nurses who can do various procedures than to have five nurses who are only trained to provide certain types of patient care. Similarly, reviewing the qualifications of doctors may help to determine if any of them need additional training to enhance quality and deliverables. Reviewing staff qualifications and optimizing staff composition would help to cut costs while improving other performance outcomes.
The environment is a critical element of hospital functioning since it impacts the service quality, cost, and deliverables. About the environment, it would be beneficial to apply the TQM principles of Store and Shine, which refer to neatness and cleanliness. In terms of hiring, this means that the XYZ Hospital should have staff members who will be responsible for maintaining a clean, sanitary environment. Instead of utilizing the services of part-time cleaners, it would be better to hire several full-time cleaners to ensure that they are available at all times. This way, other staff members can focus on their roles instead of cleaning.
Another critical aspect of the environment that should be considered is neatness. The manager needs to identify current issues related to misplaced materials or disorganized processes using the Gamba Walk observations. During these observations, it should be noted whether there are any delays or extra steps taken by the staff in performing specific processes. For example, if nurses have to walk to a different room every time they need wipes, this could create process delays and disrupt the environment. This, in turn, could lead to poor quality of services provided in the hospital.
Once the problems are identified, the total flow approach to process improvement should be used by identifying optimal environmental adjustments. In the example above, it would be helpful to place some materials in every patient ward so that nurses would not have to walk to a different room to get them. Optimizing the environment to support the process flow is essential to improving the quality of services provided by the hospital. This can also help to reduce the costs by improving the efficiency of staff. If nurses can complete their activities faster in an optimized environment, the hospital’s staff needs will decrease, allowing for labor cost savings.
Methods refer to specific processes that take place in the organization to achieve the desired results. In the XYZ Hospital, there is a great variety of processes that relate to the services provided. These include diagnostic and treatment procedures, as well as the routine and administrative processes required to maintain the environment and support care delivery. One of the most critical principles in total flow management is standardization. Standardization has many benefits, including better opportunities for evaluation and reduced quality variation (Goetsch and Davis 279). Standardization requires identifying best practices, creating step-by-step guides for staff, and monitoring their compliance. This helps to improve methods in terms of time- and cost-efficiency while also achieving optimal outcomes.
Standardization is probably the most challenging task for the quality manager in this case since it requires extensive observations and research into current processes. To begin the process, the quality manager will need to review existing procedures for efficiency and monitor the staff’s compliance with them. If there are gaps in both the methods and the staff’s compliance with them, the procedures should be amended to promote time- and cost-efficiency. To identify the gaps and develop new procedures, the quality manager will need to research scholarly evidence on best practices and use official process guidelines to improve processes. This will help to enhance the methods used in the organization in terms of their efficiency, quality, and deliverables.
Measurement is an essential aspect of total quality and total flow management since it helps to monitor progress. Measurement also relates to the principle of Sustainability, which is essential in continuous quality improvement (Goetsch and Davis 278). For the quality manager, it would be useful to review the current system of measurement and amend it in a way that promotes a more accurate description of deliverables.
Observations made concerning materials, machines, manpower, the environment, and methods can help to identify areas of concern that should be measured regularly. In many hospitals, quality measurement is limited to patient outcomes and incidents. This approach does not provide an accurate representation of service quality since it may cause managers to miss vital indicators of rising costs and decreasing quality. Hence, a more useful measurement system would involve a wide variety of key performance indicators (KPIs). Goetsch and Davis recommend determining KPIs based on the organization’s critical success factors, as this helps to use them strategically (388). In the XYZ hospital, KPIs should include, at the very least, patient outcomes, treatment cost per patient, patients’ or parents’ satisfaction, and cleanliness rating. Additionally, it would be useful to add process-based metrics, such as incidents or repeated diagnostic or treatment procedures, staff hours spent on individual processes, and other relevant indicators. This would help to measure improvements both in operations and in their outcomes.
Once a new measurement system has been developed, the current performance in each KPI should be measured and realistic, time-bound goals should be set. The goals should be communicated to all staff members to ensure that they support new standards in their work. Regular review of KPI and comparison of actual indicators to goals, as well as rewards for achievement, could help to motivate staff and achieve better outcomes. The implementation of the new measurement system is likely to be completed in two to three months, and thus it would also support improvements in other areas, such as materials, machines, and methods.
On the whole, problems in costs, quality, and deliverables present significant challenges for the XYZ Hospital and require substantial improvement throughout the organization. The paper explained total quality and total flow tools, techniques, and processes that should be used to achieve better outcomes in all three indicators. Implementing these recommendations will help the hospital to provide better services to patients while also developing profitability and avoiding negative deliverables.
Goetsch, David L., and Stanley Davis. Quality Management for Organizational Excellence: Introduction to Total Quality. 7th ed., Pearson Education, 2014.