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ADVANCE PATHOLOGY
1.1A TOTAL QUALITY MANAGEMENT IN HEALTH CARE

HOSPITAL ERRORS
Surgical instruments/ supplies (i.e. scissors / gauze) left
inside the body after surgery.
Surgical removal of the wrong organ / tissue.
Going home with the wrong baby after giving birth.
Acquiring a disease from the hospital.
Switching of records / lab test results thus getting the
wrong diagnosis.
Hospital that ask for down payment before giving
treatment.
Transfusion of contaminated blood.
Missing or lost records.
Mistake in administering the anesthesias

QUALITY
Do it right for the first time
Conformance to requirements
Customer satisfaction
Quality = Zero defect

CUSTOMERS
EXTERNAL CUSTOMERS
People outside of your office who depend or are
beneficiaries of your service
INTERNAL CUSTOMERS
People inside of your office with whom you are either
reporting to or working with

THE COST OF 99.9% QUALITY

6 newborns will be given to the wrong patient
480 pieces of mail will be mishandled every hour
315 entries in the Webster's dictionary will be
misspelled
2,120 incorrect drug prescription will be written this year
It is always best to have 100% quality!
WHAT IS VALUE ADDED
It is the wealth created by the products and/or services
generated by an organization

NON VALUE ADDING ACTIVITIES IN ORGANIZATIONS

Waiting time

Unnecessary process steps

Process waste/overproduction/material waste

Bottlenecks

- Meals served properly

- Accuracy of charges, completeness of bill

SERVICE QUALITY DIMENSIONS

TANGIBLES
Appearance of physical facilities, equipments, staff and
communication materials
- Healing ambience
- Reception and information area
- Elegance
- Level of hygiene and cleanliness
- Staffing
- Right equipments in the proper area
RELIABILITY
Ability to perform the promised service dependably and
accurately
- Information given is reliable and complete
- The procedure will take place as scheduled

RESPONSIVENESS
Willingness to help patients and other customers and to
provide prompt service
- Promptness in response to calls
> a. phone calls
> b. patient call
- Promptness in solving bill problems
ASSURANCE
Knowledge and courtesy of staff and their ability to
convey trust and confidence
I. Competence
- Well trained personnel
II. Courtesy
- Politeness, respect, consideration & friendliness of
the staff
III. Credibility
- Trustworthiness, believability, honesty of the service
provider
IV. Security
- Freedom from danger, risk or doubt
EMPATHY
Caring, individualized attention the hospital provides its
patients and other customers
I. Access
- Approachability and ease of contact
II. Communication
- Keeping patients and other customers informed in a
language they can understand and listening to them
III. Understanding the patients
- Making the effort to know patients/other customers
and their needs

TOTAL QUALITY MANAGEMENT

A comprehensive and fundamental rule or belief for
leading and operating an organization, aimed at
continually improving performance over the long term by
focusing on customers while addressing the needs of all
stakeholders.
Quality medical service

PRINCIPLES OF TQM
Customer-driven organization.
Leadership
Involvement of the people
Process approach
System approach to management
Continual improvement
Factual approach to decision.
Mutual beneficial supplier relationship.

QUALITY ASSURANCE
The management of analytical quality depends on careful
evaluation of the imprecision and inaccuracy of laboratory
methods and the application of statistical quality control
procedures to detect medically important analytical errors that
may occur during the routine analysis.

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Advance
Pathology

1.1A TOTAL QUALITY MANAGEMENT IN HEALTH CARE

QUALITY ASSURANCE TARGET IN THE LABORATORIES

I. Pre-analytical Processes:
1. Test Ordering
2. Specimen Collection and Transport
3. Specimen Handling and Storage
II. Analytical Processes:
III. Post-analytical Processes:
1. Report Generation and delivery
2. Interpretation of Results and Subsequent Actions.

PRE-ANALYTICAL : TEST ORDERING

The mechanism for ordering tests should be designed to
facilitate ordering of measurements and examination.
Direct ordering of the clinicians improves order
accuracy.
Second-hand orders placed by nurses or clerks exhibit
higher error rates.
SPECIMEN COLLECTION & TRANSPORT
Well written procedures for specimen collection and
transport
Most critical aspect is correct patient identification and
specimen labeling.
PHLEBOTOMY should be a major focus of preanalytical efforts.
Specimen transport problems may affect laboratory
results or make the specimen worthless.
SPECIMEN HANDLING & STORAGE
The most serious specimen handling problem is
mislabeling the specimen.
Other sample handling and storage problems can affect
result accuracy or specimen usability

ANALYTICAL PROCESS
Importance of analytical quality is based on the ff:
1. Accurate
2. Reproducible
3. Timely results
POST ANALYTICAL PROCESSES
Report Generation and Delivery:
- Design, layout and readability of printed or on-screen
laboratory reports.
Interpretation of Results and Subsequent actions:
- Clinicians should be consulted to determine their
expectations and need.

OPERATING SPECIFICATIONS
The laboratory must know the imprecision and inaccuracy that
are allowable for the method and the control rules and number of
control measurements that are necessary to monitor and assure
quality of testing process.

SYSTEM OF QUALITY STANDARDS

Analytical outcome criterion
- Allowable total error
Clinical outcome criterion
- Maximum allowable standard deviation
Analytical performance criteria
- Maximum allowable bias
- Criteria for precision & accuracy

TURN AROUND TIME

Laboratory personnel generally view the TAT as the
time of receiving the specimen in the department to the
time the testing is complete.
A key factor in user satisfaction
To a clinician, TAT for a laboratory test extends from the
time the order for a test is written until a result is
reviewed.
The seemingly simple process of laboratory ordering
comprises many steps, including: physician ordering
blood extraction specimen transport entry into the
hospital information system .. etc until you get the
results.
It is a measure of efficiency and can highlight variations
in the processes so that these processes can be
improved.
most noticeable sign of performance to clinicians
draw comments immediately when prolonged
goes unnoticed when adequate
Faster TAT = > satisfaction of laboratory service
Slower TAT = dissatisfaction
The manner in which physicians use laboratory data
generally dictates that the faster the TAT the better.
Laboratories continually strive to improve the status of
their TATs.
A rapid TAT on some tests is essential for proper patient
care.
The more timely and rapidly testing is performed the
more efficient and effective will be the treatment.
That is why laboratories continually strive to improve
their TATs.
There are tests that requires rapid TAT like that of
cardiac enzymes and ABGs.
Generally, the more timely and rapidly testing is
performed, the more efficient and effective will be the
treatment.
To analyze and improve TATs

All three phases have to be examined because deficiencies can

occur at any level

Examine whole process

Highlight phase where problem exists
Solution for the problem phase
In order to improve a TAT, the process has to be
examined to highlight the phase where the problem
exists. The deficient phase has to be targeted so the
solution can be presented

Studies shows that the increased TAT is RARELY due

to ANALYTIC PHASE.(Saxena and Wong, 2005).
90% of increased TAT were outside of control in the
laboratory falling into the PRE-ANALYTIC PHASE
followed by post-analytic phase. (Valenstein,2005)
Very significant to know to decrease TAT is by
improving specimen collection and transport to and
handling within the laboratory.
Many laboratories receive complaints about test TAT.
What is an acceptable TAT?
In hospital-based labs - complaint of slow TAT will,
usually, be from the ER.

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Advance
Pathology

1.1A TOTAL QUALITY MANAGEMENT IN HEALTH CARE

Many laboratories receive complaints about TAT.

Yet there is little agreement about what constitutes
acceptable tat, which suggests that opinions of what a
tat ought to be are not based on objective analysis or
uniform experiences.

INCREASED TAT
Dissatisfaction
Prolong length of stay
Delayed disposition of ER patients
Stimulate duplicate test requests
Encourage STAT testing
Delay patient discharge
Dissatisfaction

PROLONGED TAT MAY CAUSE

Dissatisfaction with lab service
Prolong length of stay for patients in a hospital
Significant contributor to delayed disposition of patients
in the ER
Stimulate duplicate test requests
Encourage stat testing
Delay discharge of patient from hospital - both physician
and patient dissatisfied

WEIGH THE NEED VS THE FINANCIAL COST

Good quality?
Low cost?
Fast turnaround time?

Good quality, rapid results ~ expensive

Good quality, low-cost ~ slower
Low-cost, rapid results ~ sacrifice quality

The need for improvement of the TAT has to be

weighed against the financial cost of this improvement
to the institution. "Good quality, low cost, or fast
turnaround time.. you can usually have any two. Good
quality and rapid results tend to be expensive; goodquality and low-cost results tend to be slower; low-cost
and rapid results can generally be available at a
sacrifice of quality"

There is no universal cure for turnaround time problems.

What works for one laboratory can fail for another.
Laboratory = Complex Organization
Give patients the best and fastest care possible.
We cannot afford to lose patients because of poor
satisfaction with service.
TAT is a key factor in patient care satisfaction.
Literature shows that ANALYTIC phase is not commonly
they're are in need of improvement
The pre-analytic and post-analytic phase contributes to
increasing the TAT which occurs outside of the function
and control of the laboratory.
Cooperation from the Clinicians will significantly shorten
the TAT.
BASIC REQUIREMENTS IN TQM
Top management support
Willingness to change for the better
Commitment of the whole organization

APPROACH TO QUALITY MANAGEMENT IN HEALTH CARE

____________________________________________________
END OF TRANX
"Things work out best for those who make the best of how things work out." -John Wooden

POSSIBLE SOLUTIONS
Pneumatic tubing systems
Conveyors
Point of care testing
Stat laboratories
Computer technology
Courier services
Mobile laboratory
Improved instrumentation
Educate lab personnel
Communicate with physicians
Communicate with nurses
Exercise good management

IMPROVED TAT
1.Satisfied physician
2.Satisfied patient
3.Happier hospital administration
4.Improved staff's attitude

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