The Sankara Nethralaya Academy Conducted a Session on Total Quality Management in Healthcare on 13.06.2015.

Quality Management in Healthcare

Dr T V Subramaniam delivering a lecture on Total Quality Management

This penultimate session handled by Dr T V Subramaniam dealt with various principles, processes and performance measure that constitute Total Quality Management.

Quality Guru & Sankara Ratna Dr TV Subramaniam( Dr TVS) is currently the Chairman Board of Studies at Bharathidasan Institute of Management, Trichy and Visiting faculty at IIFMR,Chennai & Sankara Nethralaya Academy With a PhD from IIM Ahmedabad he has to his credit, 38 years of Corporate & Management consulting, training & teaching, Having handled around 50 major consultancy assignments for public & private sector organizations and conducted more than 600 management development programmes, he is also the recipient of the Honorary Fellow Award for Significant contribution from the Indian Institute of Materials Management.

The origin of Quality Assurance could be traced to the Inspection Era, wherein the product was inspected for compliance to acceptable standards. This later gave way to process inspection and finally the inputs that go into the processing of a product, were surveyed for standards in quality. Quality Control refers to the procedure of identification of the defects at the end of the entire processing whereas Quality Assurance and Quality Standards happen in the preventive phase of processing to avoid wastage of resources.

The growth and development of an organization depends on the level of co-ordination and design of its processes and policies to ensure that all activities that take place within are working in tandem towards a common goal. In a healthcare setting, the complexity of these co-ordination increases due to the nature of business, volume of patients, use of technology along with manual inputs, logistic hurdles and so on. Therefore it is all the more important to set up stringent standards to assess quality in such processes that deal with human life.

This is particularly unique to the hospital industry because here, the product and the end-user are the same ie., the patient himself. The customer is an observer of all activities of the organization; therefore he is in a stronger position to question discrepancies immediately unlike the manufacturing sectors. Yet another significant difference between other industries and healthcare is the value of the human element involved. Patient profiles are not defined unlike inputs in other segments that are clearly pre-defined.

The basic tenet of good quality service is to meet and then exceed customer expectations. The customer in a healthcare industry refers to the patient. The care delivered should be right the first time, every time and on time so that the maximum benefit is achieved.

Some of the guiding principles for good total quality management were elucidated with insightful illustrations.

• The most important being total customer focus, therefore all policies, plans and systems of all people in the organization should be trained towards securing a positive outcome of good judgement by the customer. If the patient is a customer to the entire hospital network, then the employee too is a customer in the context of the inter-departmental work that goes on in a hospital.

• Yet another important principle to keep in mind is the continual pursuit of excellence in quality of services by taking small measurable steps towards perfection.

• Quality Management is important to strengthen every part of the process to ensure enhanced output to the customer and also to help decision making and deploy action based on the analysis and interpretation of relevant information collected.

• Cross-functional perspective refers to the inter-related activity approach as every person/activity affects and in turn is affected by others.

• The Deming wheel of PDCA – PLAN-DO-CHECK-ACT – can be a useful tool for achieving overall efficiency in the organization.


An innovative and valuable method to sustain standards in patient quality care would be to involve every employee of the healthcare organization in decisions and development of the organization by inculcating a sense of belonging. This will bring about total employee involvement and will in turn help in identifying and channelizing their potential for the betterment of the hospital.

To ensure continuous development of not just the hospital but the employee within, it is important to continually encourage the employees by asking for their suggestions, guiding them and then delegating responsibilities, after imparting requisite knowledge and skills training.

A sure formula for retention of good quality workforce is the note of appreciation of exceptional efforts put in by an employee in the event of a difficult situation.

Adequate training should be planned to impart not just conceptual knowledge to staff but to apply it to real-time contexts while keeping the organization’s vision in focus. This, together with the imbibed values, behavior and attitude of the person at work, will surely contribute to a substantially improved performance.


Any crisis at work should be resolved not just rationally, but also effectively and efficiently. There could be several ways to resolve any critical situation in a department but it is usually optimal to have a quality circle with at least one external member to continually monitor the performance.

An effective approach to any policy-decision making should involve the following:

Analysis refers to the existing process documentation.

Measurement of baseline process performance data is crucial to identifying gaps in performance and will set scope for improvement.Setting up improvement goals and working towards development and implementation of the same initially on a trial basis.Evaluation consists of assessing the impact and then standardizing the process with periodic monitoring.

The session was enriched throughout with the enlightening anecdotes from the extensive experience of the speaker, thanks to his varied professional associations spanning several decades. The participants found the session to be lively and thought-provoking.

The high power Session on Total Quality Management in Healthcare closed with a Vote of Thanks by Mr A Mahalingam, Deputy Registrar – The Sankara Nethralaya Academy.

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