5) Combine data as necessary and calculate desired metrics such as averages. Adjustments may have to be made concerning the pace of work – staff may be working faster or slower than normal, for example. If the objective is to determine the percentage of time used for a particular item of work then work sampling methods may be used. This is a helpful technique that is less distracting for the staff than direct time study observations. Steps for work sampling are: 1) Make preliminary observations to determine the variability of the data and the probability of observing items to be measured. This is necessary to determine necessary sample size. 2) Determine sample size for desired level of accuracy and confidence level. 3) Train observers as to how to make observations and what they are to record. 4) Select a method to initiate random observations in terms of their frequency and occurrence. The idea is to observe randomly so that all relevant times have an equally likely chance of being selected. 5) Make observations on random basis and record the data. 6) Using the results calculate the desired metrics and determine if the information meets the objectives of the study. There are a number of ways to measure the time and effort involved in work. The particular approach will depend on what information is needed and the environment in which work is being done.
Page 88 Draft 5. 5.2016 52. Total Quality Management (TQM) a. Definition: Total Quality Management (TQM) is a structured approach to improving and maintaining quality utilizing an organization’s entire team, including physicians. It contrasts with the quality assurance idea (QA) which is concerned with meeting specified standards. Important elements in TQM include the idea of continuous ongoing improvement and the involvement of employees working towards a common goal. As in Lean, Six-Sigma and other QI methods there is a focus on the customer or patient’s determination of what constitutes quality. There is no universally accepted definition of the details of TQM which varies among the organizations adopting it. Particular tools of TQM include PDSA, identification of the patient’ s expectations, and quality standards which are discussed elsewhere in this handbook. b. Literature: Deming, W. Edwards. "Out of the crisis, Massachusetts Institute of Technology." Center for advanced engineering study, Cambridge, MA 510 (1986). Deming is generally credited as the founder of TQM and many of the ideas are represented in many QI methods. Short, P. J. "Total quality management in hospitals." Total Quality Management 6.3 (1995): 255- 264. c. Example A hospital wished to upgrade its ability to perform with high quality and involve the entire hospital staff in the process as well as provide a new image to the public. Several approaches were possible, such as pursing a Baldrige Award or getting an ISO 9000 certification, but TQM seemed to better fit their situation. TQM materials provided a structure and training content regarding how to improve and maintain quality. A challenge was the fact that TQM added to the already busy schedules of the staff and it was necessary to budget for such costs that this implies. TQM became the basis for the evaluation and
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