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CQI of Emergency Services article

CQI of Emergency Services article - FEATURE ARTICLE...

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FEATURE ARTICLE Continuous Quality Improvement of Emergency Services By Thomas W. Whipple and Vicki L Edick I ncreasing competitive dif- ferentiation and service quality have become prior- ities for health care providers. Because innova- tions in health care are copied easily, hospitals tend to focus on differentiating their image. One way to accomplish this is to deliver consistently higher quali- ty service than competitors. In 1987, a new management team was concerned about improving Lake Hospital System's (LHS) quality at two hospitals and four outpatient facilities. LHS management had assured themselves that they were meeting technical quality standards through quality assurance (QA) programs. However, adherence to QA standards tends to be a negative process that focuses on tine "who" m problem identifica- tion and Idle solution of clinical practice outcomes. Continuous quali- ty improvement (CQI) seeks the "why" of a problem (Darr 1991). According to Deming (1986), 85% of problems are the fault of the process. LHS management realized that they should not assume patients are satisfied simply because the staff provides good technical service. Because patients cannot judge technical quality, they rely upon their judgments of functional quality (Gronroos 1982). Consumers' perceptions of service quality are based on the manner in which the service is delivered as well as the outcome of the service provided (Mangold and Babakus 1991). In light of these findings, LHS managers decided to become more customer-oriented and concern themselves with the process of achieving functional quality. They concluded that patient satisfaction should be measured to monitor quality. Health care services are among the most difficult to evalu- ate. They are perishable, essentially intangible, and heteroge- neous. Their quality depends on who provides them and when T he authors describe a five-year continuous quality improvement program that monitors inpatient and outpatient satisfaction loith emer- gency services offered by a multi-institutional health care system. The program provides man- agers with the information to develop detailed plans for service improvement and suggests ways to appraise performance and recognize personnel. and where they are provided. And they do not result in the ownership of anything (Kotler and Andreasen 1987). Because services are consumed by the patient at the same time they are produced, the buyers of health services look for signs or evi- dence of service quality before they buy to reduce uncertainty (Mangold and Babakus 1991). They draw inferences about the quality of the service from the place, people, equipment, symbols, communication material, and price that they see. Customers generally will rely more on word-of-mouth than on advertising and put weight on physical cues such as the appearance of the facilities. Because health services are ren- dered by people, people become part of the service. This insep- arability characteristic of health services results in the
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