Integrated approach to healthcare quality management:a case study

Purpose - The purpose of the paper is to develop an integrated quality management model, which identifies problems, suggests solutions, develops a framework for implementation and helps evaluate performance of health care services dynamically. Design/methodology/approach - This paper uses logical framework analysis (LFA), a matrix approach to project planning for managing quality. This has been applied to three acute healthcare services (Operating room utilization, 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 paper shows LFA application in three service processes in one hospital. However, ideally this is required to be tested in several hospitals and other services as well. Practical implications - In the paper the proposed model can be practised in hospital-based healthcare services for improving performance. Originality/value - The paper shows that 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 health care delivery and corrective measures are taken for superior performance, there is an absence of an integrated approach, which can identify and analyze issues, provide solutions to resolve those issues, develop a project management framework (planning, monitoring, and evaluating) to implement those solutions in order to improve process performance. This study introduces an integrated and uniform quality management tool. It integrates operations with organizational strategies. © Emerald Group Publishing Limited.

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.

The complements towards developing a new risk management framework and Its applicability to the Nigerian power sector

The availability of regular supply has been identified as one of the major stimulants for the growth and development of any nation and is thus important for the economic well-being of a nation. The problems of the Nigerian power sector stems from a lot of factors culminating in her slow developmental growth and inability to meet the power demands of her citizens regardless of the abundance of human and natural resources prevalent in the nation. The research therefore had the main aim of investigating the importance and contributions of risk management to the success of projects specific to the power sector. To achieve this aim it was pertinent to examine the efficacy of risk management process in practice and elucidate the various risks typically associated with projects (Construction, Contractual, Political, Financial, Design, Human resource and Environmental risk factors) in the power sector as well as determine the current situation of risk management practice in Nigeria. To address this factors inhibiting the proficiency of the overarching and prevailing issue which have only been subject to limited in-depth academic research, a rigorous mixed research method was adopted (quantitative and qualitative data analysis). A review of the Nigeria power sector was also carried out as a precursor to the data collection stage. Using purposive sampling technique, respondents were identified and a questionnaire survey was administered. The research hypotheses were tested using inferential statistics (Pearson correlation, Chi-square test, t-test and ANOVA technique) and the findings revealed the need for the development of a new risk management implementation Framework. The proposed Framework was tested within a company project, for interpreting the dynamism and essential benefits of risk management with the aim of improving the project performances (time), reducing the level of fragmentation (quality) and improving profitability (cost) within the Nigerian power sector in order to bridge a gap between theory and practice. It was concluded that Nigeria’s poor risk management practices have prevented it from experiencing strong growth and development. The study however, concludes that the successful implementation of the developed risk management framework may help it to attain this status by enabling it to become more prepared and flexible, to face challenges that previously led to project failures, and thus contributing to its prosperity. The research study provides an original contribution theoretically, methodologically and practically which adds to the project risk management body of knowledge and to the Nigerian power sector.

A total quality management methodology for universities

This research document is motivated by the need for a systemic, efficient quality improvement methodology at universities. There exists no methodology designed for a total quality management (TQM) program in a university. The main objective of this study is to develop a TQM Methodology that enables a university to efficiently develop an integral total quality improvement (TQM) Plan. ^ Current research focuses on the need of improving the quality of universities, the study of the perceived best quality universities, and the measurement of the quality of universities through rankings. There is no evidence of research on how to plan for an integral quality improvement initiative for the university as a whole, which is the main contribution of this study. ^ This research is built on various reference TQM models and criteria provided by ISO 9000, Baldrige and Six Sigma; and educational accreditation criteria found in ABET and SACS. The TQM methodology is proposed by following a seven-step metamethodology. The proposed methodology guides the user to develop a TQM plan in five sequential phases: initiation, assessment, analysis, preparation and acceptance. Each phase defines for the user its purpose, key activities, input requirements, controls, deliverables, and tools to use. The application of quality concepts in education and higher education is particular; since there are unique factors in education which ought to be considered. These factors shape the quality dimensions in a university and are the main inputs to the methodology. ^ The proposed TQM Methodology is used to guide the user to collect and transform appropriate inputs to a holistic TQM Plan, ready to be implemented by the university. Different input data will lead to a unique TQM plan for the specific university at the time. It may not necessarily transform the university into a world-class institution, but aims to strive for stakeholder-oriented improvements, leading to a better alignment with its mission and total quality advancement. ^ The proposed TQM methodology is validated in three steps. First, it is verified by going through a test activity as part of the meta-methodology. Secondly, the methodology is applied to a case university to develop a TQM plan. Lastly, the methodology and the TQM plan both are verified by an expert group consisting of TQM specialists and university administrators. The proposed TQM methodology is applicable to any university at all levels of advancement, regardless of changes in its long-term vision and short-term needs. It helps to assure the quality of a TQM plan, while making the process more systemic, efficient, and cost effective. This research establishes a framework with a solid foundation for extending the proposed TQM methodology into other industries. ^

Indoor environment and the impact on the health of pre-exisiting asthmatics at work: the development of a risk management framework

This thesis examines the spatial and temporal variation in nitrogen dioxide (NO2) levels in Guernsey and the impacts on pre-existing asthmatics. Whilst air quality in Guernsey is generally good, the levels of NO2 exceed UK standards in several locations. The evidence indicates that people suffering from asthma have exacerbation of their symptoms if exposed to elevated levels of air pollutants including NO2, although this research has never been carried out in Guernsey before. In addition, exposure assessment of individuals is rarely carried out and research in this area is limited due to the complexity of undertaking such a study, which will include a combination of exposures in the home, the workplace and ambient exposures, which vary depending on the individual daily experience. For the first time in Guernsey, this research has examined NO2 levels in correlation with asthma patient admissions to hospital, assessment of NO2 exposures in typical homes and typical workplaces in Guernsey. The data showed a temporal correlation between NO2 levels and the number of hospital admissions and the trend from 2008-2012 was upwards. Statistical analysis of the data did not show a significant linear correlation due to the small size of the data sets. Exposure assessment of individuals showed a spatial variation in exposures in Guernsey and assessment in indoor environments showed that real-time analysis of NO2 levels needs to be undertaken if indoor micro environments for NO2 are the be assessed adequately. There was temporal and spatial variation in NO2 concentrations measured using diffusion tubes, which provide a monthly mean value, and analysers measuring NO2 concentrations in real time. The research shows that building layout and design are important factors for good air flow and ventilation and the dispersion of NO2 indoors. Environmental Health Officers have statutory responsibilities for ambient air quality, hygiene of buildings and workplace environments and this role needs to be co-ordinated with healthcare professionals to improve health outcomes for asthmatics. The outcome of the thesis was the development of a risk management framework for pre-existing asthmatics at work for use by regulators of workplaces and an information leaflet to assist in improving health outcomes for asthmatics in Guernsey.

Service level agreement management framework for utility-oriented computing platforms

With the increasing popularity of utility-oriented computing where the resources are traded as services, efficient management of quality of service (QoS) has become increasingly significant to both service consumers and service providers. In the context of distributed multimedia content adaptation deployment on service-oriented computing, how to ensure the stringent QoS requirements of the content adaptation is a significant and immediate challenge. However, QoS guarantees in the distributed multimedia content adaptation deployment on service-oriented platform context have not been accorded the attention it deserves. In this paper, we address this problem. We formulate the SLA management for distributed multimedia content adaptation deployment on service-oriented computing as an integer programming problem. We propose an SLA management framework that enables the service provider to determine deliverable QoS before settling SLA with potential service consumers to optimize QoS guarantees. We analyzed the performance of the proposed strategy under various conditions in terms of the SLA success rate, rejection rate and impact of the resource data errors on potential violation of the agreed upon SLA. We also compared the proposed SLA management framework with a baseline approach in which the distributed multimedia content adaptation is deployed on a service-oriented platform without SLA consideration. The results of the experiments show that the proposed SLA management framework substantially outperforms the baseline approach confirming that SLA management is a core requirement for the deployment of distributed multimedia content adaptation on service-oriented systems.

Combination of product quality management and exports: The case of Colombian fruits companies

Quality management provides to companies a framework to improve quality in overall systems, reduction of costs, reallocation of resources efficiently, correct planning of strategies, prevent or correct errors in the right time and increase the performance of companies. In this text, we discuss the different theories in this field, their obligatory or non-obligatory compliance, the importance of quality management for exporting companies and a case study of a Colombian firm that its main objective is to manage quality. In conclusion, we find out that there is different types of quality management systems such as Juran’s trilogy, Deming 14 points, Six sigma, HACCP, and so on; also that companies have to manage suppliers and that quality has a positive influence on exports volume; in the case of Colombian small and medium enterprises, it can be mentioned that the majority has implemented tools regarding quality management but is not enough.

Towards a service portfolio management framework

Services in the form of business services or IT-enabled (Web) Services have become a corporate asset of high interest in striving towards the agile organisation. However, while the design and management of a single service is widely studied and well understood, little is known about how a set of services can be managed. This gap motivated this paper, in which we explore the concept of Service Portfolio Management. In particular, we propose a Service Portfolio Management Framework that explicates service portfolio goals, tasks, governance issues, methods and enablers. The Service Portfolio Management Framework is based upon a thorough analysis and consolidation of existing, well-established portfolio management approaches. From an academic point of view, the Service Portfolio Management Framework can be positioned as an extension of portfolio management conceptualisations in the area of service management. Based on the framework, possible directions for future research are provided. From a practical point of view, the Service Portfolio Management Framework provides an organisation with a novel approach to managing its emerging service portfolios.