Implementation of Total Quality Management at Başkent University

Implementation of total quality management (TQM) in health care delivery systems has been well accepted in many countries and has brought continuous improvement in different areas of the health care delivery system, as well as controlling the rise of health care costs. Reports in a number of journals of the successful implementation of TQM systems encouraged us at the University of Bas,kent to introduce this approach to continuous improvement in our health services in different health facilities of the University. Ba§kent University, founded in 1993, has a 75-bed general hospital, Ankara Hospital, which gives high priority to health sciences programs. The University has two sister hospitals, one in Izmir Province and one in the Aya§ district of Ankara. Four hemodialysis centers of the University are also in operation in different provinces. The TQM philosophy and process are based on a data-oriented system which requires the participation of all staff members in an organization. In January 1994, at the beginning of Bas,kent University's implementation of a TQM process, the senior managers at Ankara Hospital were briefed about the importance of their commitment to the project. This was followed by a training program for mid-level managers, concentrating mostly on problem-solving methods. Subsequently, the staff in the clinical, laboratory and administrative departments of the hospital were included in the training program. The training consisted of an overview of the philosophy and processes of TQM, including data collection, analysis of the data and problem-solving. Each group was taught about data collection processes and about analysis of this data, including how to use the information obtained as the basis for decision-making. Optimal standards for data collection were defined for each unit based on the infra-structure of the organization and matched to the knowledge and skill levels of the staff. Mid-level managers, grouped into the quality circles they had formed, then conducted a thorough analysis of the data that had been collected and put forward appropriate alternatives for the solution of problems. In order to ensure coordination between units and to allow for consultation during problem-solving sessions, a system of TQM was established within the University Hospital. All unit heads were asked to prepare monthly quality assurance reports, including a discussion of their findings and future plans to improve quality and efficiency in their units. The TQM Coordination Group assembled data from the units and presented them to the senior managers of the hospital at their monthly meeting. By means of these reports, the senior managers were able to evaluate developments in the hospital, and the proposals of different units were discussed as an important source of information for decision-making. Here are a few examples of early improvement efforts in some of our hospital units: