Quality Improvement: A Review of Literature

The findings of this literature review are presented in three major discussions. Literature related to the quality improvement concept is reviewed first, while literature related to the principles of reorganization and reconstruction within a quality improvement environment is reviewed second. Literature related to the interrelationships between quality improvement programs and reorganization and restructuring in hospital settings is reviewed in the third discussion.

Quality improvement is sought in contemporary organizations through the implementation of strategies based on concepts with names such as TQM (total quality management), CQI (continuous quality improvement), and others. These various concepts are highly interrelated, and quality improvement in most organizations is dependent upon strategies that embrace a combination of two or more of these quality improvement concepts (Marszalek-Gaucher & Coffee, 1991, pp. 83-147). A. V. Feigenbaum (1991, pp. 5-6) developed the concept of total quality control (TQC) that underlies many quality management concepts. Karou Ishikawa (1985, pp. 1-13; 1982, p. 99). contributed the concept of quality circles. James Harrington advocates the pursuit of quality through business processes as opposed to production processes. For health care delivery institutions, the most useful conceptual combination involves TQM and CQI (Melum & Sinioris, 1992, pp. 159-224).

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xercised in employee selection; that superior training be provided; that effective job-related support services be provided; and that organizations retain employees (Crosby, 1992, pp. 42-43). Service organizations must also remember that traditional "MBA programs and accounting systems don't cut in the service game. In a service business, knowledge and information are the raw materials, and the assets are loyal customers and employees. Accounting systems don't measure those. Career paths and compensation schemes fight against them" (Armstrong & Symonds, p. 102). Defining quality in health care environments is a difficult process (Nevers, 1993, p. 18). Quality in health care environments is best pursued through programs that target higher levels of patient satisfaction (Holleran, 1992, p. 4). Patient satisfaction is best attained through addressing patient needs. The concept of consumer satisfaction is the basis of the concept of quality management. Quality is an essentially meaningless term unless a perception of quality is attributed to a product by the users of the product. In the health care environment, consumer satisfaction is patient satisfaction (Tokarski, 1989, pp. 96, 98). Consumer satisfaction is difficult to

Category: Business - Q