Managing healthcare quality using logical framework analysis

Purpose - The purpose of this paper is to develop an integrated quality management model that identifies problems, suggests solutions, develops a framework for implementation and helps to evaluate dynamically healthcare service performance. Design/methodology/approach - This study used the logical framework analysis (LFA) to improve the performance of healthcare service processes. LFA has three major steps - problems identification, solution derivation, and formation of a planning matrix for implementation. LFA has been applied in a case-study environment to three acute healthcare services (Operating Room utilisation, Accident and Emergency, and Intensive Care) in order to demonstrate its effectiveness. Findings - The paper finds that LFA is an effective method of quality management of hospital-based healthcare services. Research limitations/implications - This study shows LFA application in three service processes in one hospital. This very limited population sample needs to be extended. Practical implications - The proposed model can be implemented in hospital-based healthcare services in order to improve performance. It may also be applied to other services. Originality/value - Quality improvement in healthcare services is a complex and multi-dimensional task. Although various quality management tools are routinely deployed for identifying quality issues in healthcare delivery, they are not without flaws. There is an absence of an integrated approach, which can identify and analyse issues, provide solutions to resolve those issues, develop a project management framework to implement those solutions. This study introduces an integrated and uniform quality management tool for healthcare services. © Emerald Group Publishing Limited.

Quality improvement in professional local government services : a longitudinal study

This sustained longitudinal study, carried out in a single local authority, investigates the implementation of a Total Quality Management (TQM) philosophy in professional local government services. At the start of this research, a large majority of what was written about TQM was polemical and based on limited empirical evidence. This thesis seeks to provide a significant and important piece of work, making a considerable contribution to the current state of knowledge in this area. Teams from four professional services within a single local authority participated in this research, providing the main evidence on how the quality management agenda in a local authority can be successfully implemented. To supplement this rich source of data, various other sources and methods of data collection have been used: 1) Interviews were carried out with senior managers from within the authority; 2) Customer focus groups and questionnaires were used; 3) Interviews were carried out with other organisations, all of which were proponents of a TQM philosophy. A number of tools have been developed to assist in gathering data: 1) The CSFs (critical success factors) benchmarking tool; 2) Five Stages of Quality Improvement Model. A Best Practice Quality Improvement Model, arising from an analysis of the literature and the researcher's own experience is proposed and tested. From the results a number of significant conclusions have been drawn relating to: 1) Triggers for change; 2) Resistance of local government professionals to change 3) Critical success factors and barriers to quality improvement in professional local government services; 4) The problems associated with participant observation and other methodological issues used.

The interaction between the implementation of an occupational health and safety management system and safety culture:a case study in the rubber industry

A prominent theme emerging in Occupational Health and Safety (OSH) is the development of management systems. A range of interventions, according to a prescribed route detailed by one of the management systems, can be introduced into an organisation with some expectation of improved OSH performance. This thesis attempts to identify the key influencing factors that may impact upon the process of introducing interventions, (according to B88800: 1996, Guide to Implementing Occupational Health and Safety Management Systems) into an organisation. To help identify these influencing factors a review of possible models from the sphere of Total Quality Management (TQM) was undertaken and the most suitable TQM model selected for development and use in aSH. By anchoring the aSH model's development in the reviewed literature a range ofeare, medium and low level influencing factors were identified. This model was developed in conjunction with the research data generated within the case study organisation (rubber manufacturer) and applied to the organisation. The key finding was that the implementation of an OSH intervention was dependant upon three broad vectors of influence. These are the Incentive to introduce change within an organisation which refers to the drivers or motivators for OSH. Secondly the Ability within the management team to actually implement the changes refers to aspects, amongst others, such as leadership, commitment and perceptions of OSH. Ability is in turn itself influenced by the environment within which change is being introduced. TItis aspect of Receptivity refers to the history of the plant and characteristics of the workforce. Aspects within Receptivity include workforce profile and organisational policies amongst others. It was found that the TQM model selected and developed for an OSH management system intervention did explain the core influencing factors and their impact upon OSH performance. It was found that within the organisation the results that may have been expected from implementation of BS8800:1996 were not realised. The OSH model highlighted that given the organisation's starting point, a poor appreciation of the human factors of OSH, gave little reward for implementation of an OSH management system. In addition it was found that general organisational culture can effectively suffocate any attempts to generate a proactive safety culture.

An integrated view of data quality in earth observation

Data quality is a difficult notion to define precisely, and different communities have different views and understandings of the subject. This causes confusion, a lack of harmonization of data across communities and omission of vital quality information. For some existing data infrastructures, data quality standards cannot address the problem adequately and cannot full all user needs or cover all concepts of data quality. In this paper we discuss some philosophical issues on data quality. We identify actual user needs on data quality, review existing standards and specification on data quality, and propose an integrated model for data quality in the eld of Earth observation. We also propose a practical mechanism for applying the integrated quality information model to large number of datasets through metadata inheritance. While our data quality management approach is in the domain of Earth observation, we believe the ideas and methodologies for data quality management can be applied to wider domains and disciplines to facilitate quality-enabled scientific research.

Introduction : the role of quality, production and technological innovation in improving competitive performance

Quality, production and technological innovation management rank among the most important matters of concern to modern manufacturing organisations. They can provide companies with the decisive means of gaining a competitive advantage, especially within industries where there is an increasing similarity in product design and manufacturing processes. The papers in this special issue of International Journal of Technology Management have all been selected as examples of how aspects of quality, production and technological innovation can help to improve competitive performance. Most are based on presentations made at the UK Operations Management Association's Sixth International Conference held at Aston University at which the theme was 'Getting Ahead Through Technology and People'. At the conference itself over 80 papers were presented by authors from 15 countries around the world. Among the many topics addressed within the conference theme, technological innovation, quality and production management emerged as attracting the greatest concern and interest of delegates, particularly those from industry. For any new initiative to be implemented successfully, it should be led from the top of the organization. Achieving the desired level of commitment from top management can, however, be a difficulty. In the first paper of this issue, Mackness investigates this question by explaining how systems thinking can help. In the systems approach, properties such as 'emergence', 'hierarchy', 'commnication' and 'control' are used to assist top managers in preparing for change. Mackness's paper is then complemented by Iijima and Hasegawa's contribution in which they investigate the development of Quality Information Management (QIM) in Japan. They present the idea of a Design Review and demonstrate how it can be used to trace and reduce quality-related losses. The next paper on the subject of quality is by Whittle and colleagues. It relates to total quality and the process of culture change within organisations. Using the findings of investigations carried out in a number of case study companies, they describe four generic models which have been identified as characterising methods of implementing total quality within existing organisation cultures. Boaden and Dale's paper also relates to the management of quality, but looks specifically at the construction industry where it has been found there is still some confusion over the role of Quality Assurance (QA) and Total Quality Management (TQM). They describe the results of a questionnaire survey of forty companies in the industry and compare them to similar work carried out in other industries. Szakonyi's contribution then completes this group of papers which all relate specifically to the question of quality. His concern is with the two ways in which R&D or engineering managers can work on improving quality. The first is by improving it in the laboratory, while the second is by working with other functions to improve quality in the company. The next group of papers in this issue all address aspects of production management. Umeda's paper proposes a new manufacturing-oriented simulation package for production management which provides important information for both design and operation of manufacturing systems. A simulation for production strategy in a Computer Integrated Manufacturing (CIM) environment is also discussed. This paper is then followed by a contribution by Tanaka and colleagues in which they consider loading schedules for manufacturing orders in a Material Requirements Planning (MRP) environment. They compare mathematical programming with a knowledge-based approach, and comment on their relative effectiveness for different practical situations. Engstrom and Medbo's paper then looks at a particular aspect of production system design, namely the question of devising group working arrangements for assembly with new product structures. Using the case of a Swedish vehicle assembly plant where long cycle assembly work has been adopted, they advocate the use of a generally applicable product structure which can be adapted to suit individual local conditions. In the last paper of this particular group, Tay considers how automation has affected the production efficiency in Singapore. Using data from ten major industries he identifies several factors which are positively correlated with efficiency, with capital intensity being of greatest interest to policy makers. The two following papers examine the case of electronic data interchange (EDI) as a means of improving the efficiency and quality of trading relationships. Banerjee and Banerjee consider a particular approach to material provisioning for production systems using orderless inventory replenishment. Using the example of a single supplier and multiple buyers they develop an analytical model which is applicable for the exchange of information between trading partners using EDI. They conclude that EDI-based inventory control can be attractive from economic as well as other standpoints and that the approach is consistent with and can be instrumental in moving towards just-in-time (JIT) inventory management. Slacker's complementary viewpoint on EDI is from the perspective of the quality relation-ship between the customer and supplier. Based on the experience of Lucas, a supplier within the automotive industry, he concludes that both banks and trading companies must take responsibility for the development of payment mechanisms which satisfy the requirements of quality trading. The three final papers of this issue relate to technological innovation and are all country based. Berman and Khalil report on a survey of US technological effectiveness in the global economy. The importance of education is supported in their conclusions, although it remains unclear to what extent the US government can play a wider role in promoting technological innovation and new industries. The role of technology in national development is taken up by Martinsons and Valdemars who examine the case of the former Soviet Union. The failure to successfully infuse technology into Soviet enterprises is seen as a factor in that country's demise, and it is anticipated that the newly liberalised economies will be able to encourage greater technological creativity. This point is then taken up in Perminov's concluding paper which looks in detail at Russia. Here a similar analysis is made of the concluding paper which looks in detail at Russia. Here a similar analysis is made of the Soviet Union's technological decline, but a development strategy is also presented within the context of the change from a centralised to a free market economy. The papers included in this special issue of the International Journal of Technology Management each represent a unique and particular contribution to their own specific area of concern. Together, however, they also argue or demonstrate the general improvements in competitive performance that can be achieved through the application of modern principles and practice to the management of quality, production and technological innovation.

Professionalism and quality in European business courses:utilising research to enhance student learning and promote employability - a pan-European study

This..paper provides a comparative analysis of Quality Management and standards in four European countries, (the UK, Austria, Slovenia and Romania) and in doing so addresses the gap in academic knowledge about how the introduction and implementation of Quality Management Strategies can both facilitate and enhance student learning within Universities.

Decision-making in product quality based on failure knowledge

Decision-making in product quality is an indispensable stage in product development, in order to reduce product development risk. Based on the identification of the deficiencies of quality function deployment (QFD) and failure modes and effects analysis (FMEA), a novel decision-making method is presented that draws upon a knowledge network of failure scenarios. An ontological expression of failure scenarios is presented together with a framework of failure knowledge network (FKN). According to the roles of quality characteristics (QCs) in failure processing, QCs are set into three categories namely perceptible QCs, restrictive QCs, and controllable QCs, which present the monitor targets, control targets and improvement targets respectively for quality management. A mathematical model and algorithms based on the analytic network process (ANP) is introduced for calculating the priority of QCs with respect to different development scenarios. A case study is provided according to the proposed decision-making procedure based on FKN. This methodology is applied in the propeller design process to solve the problem of prioritising QCs. This paper provides a practical approach for decision-making in product quality. Copyright © 2011 Inderscience Enterprises Ltd.

Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta

Purpose – The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A&E) unit of a Maltese hospital. Design/methodology/approach – The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients’ requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A&E unit of the hospital. Findings – The major and related problems being faced by the hospital under study were overcrowding at A&E and shortage of beds, respectively. The combined framework ensures better A&E services and patient flow. QFD identifies and analyses the issues and challenges of A&E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A&E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A&E unit. Practical/implications – The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives. Originality/value – Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A&E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta.

Continuous quality improvement in a Maltese hospital using logical framework analysis

Purpose: The purpose of this paper is to present the application of logical framework analysis (LFA) for implementing continuous quality improvement (CQI) across multiple settings in a tertiary care hospital. Design/methodology/approach: This study adopts a multiple case study approach. LFA is implemented within three diverse settings, namely, intensive care unit, surgical ward, and acute in-patient psychiatric ward. First, problem trees are developed in order to determine the root causes of quality issues, specific to the three settings. Second, objective trees are formed suggesting solutions to the quality issues. Third, project plan template using logical framework (LOGFRAME) is created for each setting. Findings: This study shows substantial improvement in quality across the three settings. LFA proved to be effective to analyse quality issues and suggest improvement measures objectively. Research limitations/implications: This paper applies LFA in specific, albeit, diverse settings in one hospital. For validation purposes, it would be ideal to analyse in other settings within the same hospital, as well as in several hospitals. It also adopts a bottom-up approach when this can be triangulated with other sources of data. Practical implications: LFA enables top management to obtain an integrated view of performance. It also provides a basis for further quantitative research on quality management through the identification of key performance indicators and facilitates the development of a business case for improvement. Originality/value: LFA is a novel approach for the implementation of CQI programs. Although LFA has been used extensively for project development to source funds from development banks, its application in quality improvement within healthcare projects is scant.

Building a holarchy using business process-oriented holonic (PrOH) modeling

The application of systems thinking to designing, managing, and improving business processes has developed a new "holonic-based" process modeling methodology. The theoretical background and the methodology are described using examples taken from a large organization designing and manufacturing capital goods equipment operating within a complex and dynamic environment. A key point of differentiation attributed to this methodology is that it allows a set of models to be produced without taking a task breakdown approach but instead uses systems thinking and a construct known as the "holon" to build process descriptions as a system of systems (i.e., a holarchy). The process-oriented holonic modeling methodology has been used for total quality management and business process engineering exercises in different industrial sectors and builds models that connect the strategic vision of a company to its operational processes. Exercises have been conducted in response to environmental pressures to make operations align with strategic thinking as well as becoming increasingly agile and efficient. This unique methodology is best applied in environments of high complexity, low volume, and high variety, where repeated learning opportunities are few and far between (e.g., large development projects). © 2007 IEEE.

A model of service performance enhancement:the role of transactional and transformational leadership

This paper is concerned with the ways in which transactional and transformational leadership styles can improve the service performance of front-line staff. Past literature on services marketing has indicated the importance of leadership but has largely ignored the parallel literature in which leadership styles have been conceptualized and operationalized (e.g., sales management, organizational psychology). This paper seeks to build upon existing services marketing theory by introducing the role of leadership styles in enhancing service performance. Consequently, a conceptual framework of the effect of transactional and transformational leadership styles on service performance, anchored in a crossdisciplinary literature review, is developed. Managerial implications and future research directions are also discussed.

Innovation in healthcare services: a customer focused approach

Although the various tools and techniques of quality management are routinely deployed in order to improve healthcare quality, an integrated approach is lacking, which combines the customer focus to identify quality issues, analytical techniques for prioritising improvement measures and a project management approach to plan, implement and evaluate the improvement projects. This study develops an innovative framework using Quality Function Deployment (QFD) and a logical framework in order to address this issue, and demonstrates its effectiveness using a case study on the intensive care unit of a hospital.

Inscribing the organization:representations in dispute between accounting and production

This paper assumes that a primary function of management accounting is the representation of "accounting facts" for purposes such as organizational control. Accountants are able to offer conventional techniques of control, such as standard costing, as a consequence of their ability to deploy accounting representations within managerial and economic models of organizational processes. Accounting competes, at times, with other 'professional' groups, such as production planning or quality management people, in this role of representing the organization to management. The paper develops its arguments around a case illustration of cost accounting set in a low technology manufacturing environment. The research relates to a case organization in which accountants are attempting to establish the reliability of accounting inscriptions of a simple manufacturing process. The case research focuses on the documents, the inscriptions that vie for managements' attention. It is these sometimes messy and inaccurate representations which enable control of complex and heterogeneous activities at a distance. At the end of our site visits we observe quality management systems in the ascendancy over the accountants' standard costing systems. © 2006 Elsevier Ltd. All rights reserved.

Integrated manufacturing, empowerment, and company performance

There is controversy over whether integrated manufacturing (IM), comprising advanced manufacturing technology, just-in-time inventory control and total quality management, empowers or deskills shop floor work. Moreover, both IM and empowerment are promoted on the assumption that they enhance competitiveness. We examine these issues in a study of 80 manufacturing companies. The extent of use of IM was positively associated with empowerment (i.e., job enrichment and employee skill enhancement), but, with the minor exception of AMT, bore little relationship with subsequent company performance. In contrast, the extent of empowerment within companies predicted the subsequent level of company performance controlling for prior performance, with the effect on productivity mediating that on profit. Copyright © 2004 John Wiley & Sons, Ltd.