Total Quality Management in Health Care Sector


Mrs Sreedevi Menon
CNK Reddy College of Business Management
#193, Indiranagar 2nd stage, Double Road, Bangalore-560038

Abstract: Hospitals are by nature complex organizations and the complexity is compounded in service hospitals with perceived notion of service deficiencies. Quality has emerged as a major issue in health care sector and TQM has been accepted as a major long-term strategic initiative towards continuously improving quality of health care. Key concepts of TQM start with top management leadership with emphasis on process and customer focus. Implementation of TQM in service hospitals will require Quality Management awareness, training and framework development as well as development of customer awareness. TQM has been widely applied in clinical field with successful outcome. TQM is not a short-term solution, it has to be understood and practiced as a long-term strategic commitment

Key Words

Total Quality Management, hospital management, service quality


Quality has become one of the most important factors in global competition today. Intensifying global competition and increasing demand by customers for better quality have caused more and more companies to realize that they will have to provide quality product and /or services in order to successfully compete in the marketplace. To meet the challenge of this global revolution, many businesses have invested substantial resources in adapting and implementing total quality management (TQM) strategies. Total Quality Management refers to the deep commitment of an organization to quality. Each and every step taken by the organization to improve the quality of products and services they are providing to their customers are called Total Quality Management. TQM is a relative newcomer to hospital management. In the healthcare industry all hospitals provide the same type of service, but they do not provide the same quality of service. To achieve service excellence, hospitals must strive for zero defects, retaining every customer that they can profitably serve. Zero defects require continuous efforts to improve the quality of the service delivery system and hence this concept of TQM is having a lot of relevance in this sector. We might have come across situations like long wait for the services from doctors, nurses and other hospital staffs, low quality of treatment received from doctors which leads to repeated surgeries and expenditure for patients, which can even lead to their death. All these can be avoided by improving the total service quality.

A traditional belief regarding TQM is that 'high quality' costs more. But by implementing a proper quality system we can control the cost by:

a. Reducing unnecessary interventions.
b. Getting it right first time e.g. cost of repeat surgery
c. Avoidable complications e.g. post-operative infections.
d. Imbalances of resources: Lack of theatre time or lack of access to diagnostic facilities leading to increased length of stay.
e. Employee turnover and consequent training costs.

The dimensions of quality

Various dimensions of quality that need to be addressed are effectiveness, efficiency, technical competence, safety, accessibility, interpersonal relations, continuity and amenities. Healthcare quality does not mean that care is given by the most learned and highly experienced professors of medicine. But that the system is devised in such a way that in any situation most ordinary yet adequately trained doctor can deliver appropriate treatment to the needy patient. Quality is therefore based on the principles of cost saving. Quality calls for the principles of elimination of waste, elimination of re-work and elimination of duplication. Implementing quality in healthcare therefore means that the provision of training in quality methodologies, securing monitoring capabilities, measuring performance and improvement accomplishments and collection of necessary data for documentation of status and level of care.

Quality assessment can be done on the basis of the following factors:

* Qualification of the treating doctor
* Training status of the staff
* Attention to safety of care
* Existence of a quality system
* Excellence of the service aspect of healthcare
* Doctor's commitment to quality

Factors having impact on TQM implementation

In healthcare industry, success of TQM applications depends on a strong leadership that must be initiated by the top management. Role of top management and quality policy has the highest impact on TQM plan. Top management of the hospitals determines an appropriate organization culture, vision, and quality policy. On the other hand, the top management must provide adequate resources to the implementation of quality efforts. Another factor is employee relations. Its effect is by building quality awareness among employees and by the recognition of employees for superior quality performance. Finally process management, which includes such sub-factors as process monitoring, supervision, and preventive equipment maintenance, is having least impact on TQM implementation

Quality service in low cost:

In India, multi specialty hospitals like Narayana Hrudayalaya in association with Karnataka State Cooperative Society started a Micro Health Insurance Programme called Yeshaswin. The insurance programme has proved that by just paying Rs 5 a month, millions of poor farmers can afford to undergo any surgery, including heart surgery, totally free. So, at lowest cost high quality services are available for poor people.

E-governance plays an important role in providing high quality services

* Storing of information in digital form accessible and transferable, wherever and whenever needed is essential.

* A tele-healthcare system can be as simple as providing a patient with the means to alert a remote care provider of their need for assistance.

* Quality Assurance (QA) by Total Quality Management (TQM), medical and Nursing audits supported by computerization of all processes like store, pharmacy, finance and purchase section, inventory and administrative machinery would save money, time and transcend human error.

* Computer help should be utilized for clinical decision making for selecting suitable tests, proper interpretation, and accuracy in diagnosis and update management. Though computer can't be substitute for human brain, it is definitely useful as a neutral platform for unbiased analysis (Blobel, et. al.) to assist the physician against commission of error.

* Computerized prescription has the advantage of correct dose, duration, patient and pharmacy compliance.

Current e-health scenario in India

Some of the examples for quality improvement initiatives by the government in association with software companies are

* Wipro provided Hospital Information System (HIS) to six hospitals of DMC. This HIS has 28 modules meeting the hospital needs, like Patient registration, demographic details, outpatient visits, doctors' appointment scheduling etc

* The Tamil Nadu Government has allotted Rs 5 crore to Tata Consultancy Services (TCS) to develop a suitable solution to maintain electronic medical records (EMR).

* The World Ahead Programme is an initiative launched by Intel to provide education and healthcare service in India. In the healthcare sector, Intel has carried out tele-health projects in Baramati, Maharashtra and Trivandrum, Tamil Nadu, and child health monitoring in Chandni Chowk, Delhi.

* HP healthcare solution and Amrita Technology worked together for system integration and doctor's training.


By adopting innovative method and also by proper planning, quality of healthcare services can be improved to a great extend. By doing so, customer (patients) satisfaction can be improved and also doctors will save their precious time which can be utilized for higher professional growth. Finally good quality health care delivery at doorstep in low cost would safeguard national health leading to economic growth.


1. Mahapatra Chandra Subash, Das Krushna Rama and Patra Ranjan Manas, "Current e-Governance Scenario in Healthcare sector of India", e-Governance in practice, , page 120-126(2008)

2. Patel Gunjan, "Total Quality Management in Healthcare", September 2008 ,

3. Dilber Mustafa, Bayyurt Nizamettin, Zaim Selim, Tarim  Mehves, "Critical Factors of Total Quality Management and Its Effect on Performance in Health Care Industry: A Turkish Experience", Problems and Perspectives in Management, page no:220-229(2005)

4. Dr Harish Nadkarni," Managing the quality in healthcare industry", August2001,

5.  Elaine, "Quality management targets health care - Total Quality   management applied to hospital administration", February 1993 ,

Mrs Sreedevi Menon
CNK Reddy College of Business Management
#193, Indiranagar 2nd stage, Double Road, Bangalore-560038

Source: E-mail August 5, 2010


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