QMS is the solution for quality healthcare
Meeta Ruparel -

Primary areas where the Indian healthcare system lags behind is standard of treatment and quality of care. One way to improve the standards is establishment of monitoring systems. But attempts in many states to enact legislation for private hospitals have wound up in procedural and bureaucratic red tapeism. Implementation of Quality Management Systems (QMS), therefore is the only solution.

QMS can facilitate provision of quality and standardised healthcare service if followed diligently by various organisations. The steps for working towards QMS involve orientation steps which are:

The organisation must designate senior-level personnel to supervise QMS.

The organisation must establish a QMS committee to provide guidelines on quality management issues.

• A written policy for QMS should be stated. This policy should establish the role of the QMS committee and provide an evaluation of the program. A review of the same should then be carried out with appropriate analysis.
• The personnel delegated with appropriate responsibilities must have adequate orientation and training in quality and accreditation standards.
• The QMS must be designed to improve clinical and non-clinical services.
• The QMS committee must identify priorities by reviewing data obtained on the performance levels. Based on the analyzed reports, the committee must select performance improvement projects.
• The committee must assess current levels of performance, establish goals for improvement, and establish time frames for improvement.
• The committee must then establish strategies to improve performance for each project and periodically measure improvements.
• The previous projects should also be continuously monitored so as to further improvise and maintain the quality standards established.
• Finally, all measurements conducted should provide flexibility to change and adapt as per demands, provide comparisons and must be statistically valid.

A good QMS can be established by means of various audits, both for clinical as well as the organisational audits in terms of personnel, services, etc.

• To assess how good the organisation is in terms of quality healthcare service, there are Quality Audits (QA) systems.
• With the help of Ethical Audits (EA) one can assess how socially responsible is the organisation towards the society as well as its own staff personnel.
• Finally there is Total Quality Management (TQM) procedures for continuous assessment and improvement of the set standards and protocols, thereby ensuring effective achievement of the stated quality objectives.

The different assessment protocols for QA could be:

• Quality policy: There must be documentation of policies and procedures. Internal and external quality assurance procedures, and systems evaluation must cover the pre-analytical, analytical and post-analytical phases of each process.
• Infrastructure in terms of organisation set-up: This includes the existence of an appropriate administrative and staffing structure, with documentation of delegation of tasks and their accountability and responsibilities.
• Facilities
• Resources: Equipment, materials and other resources must be of suitable quality and appropriate for the purposes for which they are used.
• Ambience: The working environment must be safe for staff and patients, and sufficient and appropriate for the work and a means of comfort to the patients.
• Staff qualifications: There must be sufficient staff with appropriate qualifications, skill expertise and training, with provision for continuing education and assurance of staff competencies at all levels.

The different assessment protocols for EA could be:

EA systems must ensure that the staff personnel at all levels of the organisational hierarchy comply with ethical standards, such as:

• Maintenance of confidentiality of patient information
• Non-discrimination against patients or staff based on race, gender, economic status or religious beliefs.
• Compliance and adherence to appropriate technical and professional standards regardless of cost pressures.
• Preventive measures to avoid organisational conflicts (personal, financial political, etc) of interest effecting the services. * Adherence towards cost effective measures whilst rendering services.
• Adherence to high standards, such as those related to timeliness of services, accuracy and precision of diagnostic reports, clinical relevance of the treatment provided, and prevention of errors, etc. implemented with an efficient qualified, skilled and trained team of professionals. TQM protocols:

The key issues in TQM are:

• Continuous improvements: Done by regular benchmarking.
• Customer orientation: Should be in-built in the cultural work process of the organisation.
• Empowered employees: Achieved by appropriate delegation of tasks and providing the delegated staff with appropriate tools to effectively and efficiently carry out the tasks assigned.

And as rightly said by one of the pioneers in the profession of QMS, “TQM is an ongoing journey of continuous measurable improvements, led by a team of empowered individuals at all levels of the organisation, working in tandem, resulting in an enjoyable and productive work place, dedicated to the highest possible level of customer satisfaction.”

(The author may be contacted at support@meditecindia.com)