Total Quality in Healthcare: From Theory to Practice
Ellen J. Gaucher and Richard J. Coffey
Jossey-Bass, San Francisco, 1993, 615 pp., $44.95 (hardback)
This book serves as a "how-to" guide for healthcare organizations as they attempt to unfold their various quality processes. It has helpful information for executives, managers, planners, quality assurance professionals, quality facilitators and team leaders, department directors, and clinical and medical staffs.
The book is simply and concisely laid out in an easily understood organizational flow. Throughout, bold "action steps" highlight ways readers can implement ideas from the book in their own programs. These "action steps" are provided in composite form in Appendix B. Additionally, Appendix A contains a practical self-assessment tool that can serve as a beginning framework for gauging one's current quality program. And a case study illustrates the practical applications of the book's guidelines.
The book contains 16 chapters in four parts. Part one, on setting the stage for a total quality management (TQM) program, provides a discussion on why such a program should be implemented, a basic explanation of TQM, an excellent discussion of the integration of TQM with traditional quality assurance activities, and finally a chapter on the integration of TQM with other initiatives, such as guest relations programs, strategic planning initiatives, and cost-reduction activities.
Part two addresses the actual creation of a TQM culture, with chapters on organization and leadership, the organizational culture, physician involvement, teamwork, education and training, and the development of rewards and recognition for continued success of a TQM program. The chapter on physician involvement is particularly valuable. It provides an insightful overview of challenges that physicians encounter as they are approached for participation in the quality improvement process and speaks directly to those who work with medical staff leaders and with physicians themselves.
Part three covers more detailed analytical methods for TQM. The four chapters in this part describe implementation of TQM actions in daily operations, quality improvement methods, a case study of quality improvement, and finally advanced applications of TQM. The chapter on quality improvement methods details the various flow chart and diagraming processes covered by many books and articles on the subject. Of exceptional value, the last chapter addresses several activities related to TQM, such as total quality networking, just-in-time integrated systems, benchmarking, critical pathways, quality function deployment, and Hoshin planning.
This chapter was especially helpful in identifying specific problems with TQM, as was "Beyond the Glitter," one of two chapters in part four (the other being a conclusion). The candor with which these problems are identified and addressed makes Total Quality in Healthcare more practical.
I was disappointed, however, by the lack of a frank discussion on physician-developed practice parameters (also known as clinical practice guidelines). The medical staff's traditional quality management activity can serve as a foundation on which to build their involvement in the TQM process. This involvement is facilitated by integrating the development of clinical practice guidelines with case management, benchmarking, and several other activities related to TQM. However, this was the only glaring omission I found.
In conclusion, this book's value for its intended audience would be 8, on a scale of 1 to 10. The book is practical, is easy to understand and read, and touches on each of the key components of a TQM program. The chapter on "Advanced Applications of TQM" would be particularly informative for the advanced professional, whereas the discussion on the integration of TQM and quality assurance would help the beginning quality professional overcome many natural barriers that exist.
Reviewed by Wayne W. Wasden, Vice President of Quality Management, Alexian Brothers Medical Center, Elk Grove Village, IL
Copyright © 1994 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.