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Show the modified version of the Ten-Step Process, but incremental changes in the standards will help create a corporate culture emphasizing continuous improvement in quality. Anderson and Daigh (1991) compared "quality thinking" (TQM) with traditional management in Table 2: When these ten principles are applied to healthcare processes, it was found that "costs can decline and employee motivation can increase, bringing improved operations" (Anderson & Daigh, 1991). The most important aspect, however, is the focus upon the interrelatedness of all work processes and activities. With a focus upon process, TQM and CQI can address issues which can improve and maintain patient satisfaction. Quantitative and qualitative measures utilized in the Ten-Step Process can serve as tools for evaluation and reform: how are patients received at the institution? What is the admissions process? Are patients prepared for their hospital stay? Do they know what to expect? How long do patients wait in clinics or ancillary departments? How many complaints regarding billing procedures do we receive? How much money do we waste dealing with billing errors? Do patients adequately understand their prognosis? Improvements in quality through improved processes can be achieved by answering such questions and implementing solutions, but the questions must be asked again and again. The goal is continuous improvement Hospital administrators have begun the arduous task of effecting the fundamental changes in institutional cultures and processes necessary to implement TQM and CQI. A 1992 Hospitals survey revealed that 58.5 percent of hospital CEO respondents are now implementing a TQM or CQI program. "In addition, of the 41.5 percent of respondents who haven't yet implemented such a program, 84.6 percent say they plan to..." (Eubanks, 1992). Healthcare executives who lead organizations implementing CQI or TQM must possess certain competencies and values such as: • Mastering change. Executives must help their organizations view change as an opportunity for new alternatives and calculated risk taking. • Systems thinking. They must be able to see the whole picture, understand relationships and patterns, and identify points of leverage to restabilize and achieve goals. • Shared vision. Executives must craft a collective organizational vision and articulate a preferred future. • Redefining healthcare. Executives need to be involved in the growing focus on changing lifestyles, health and healing ~ rather than disease and body parts - to create high-functioning individuals and healthy communities. • Serving the public and the community. They must successfully weld social mission to organizational goals, objectives, and actions versus maximizing short-term profitability (Eubanks, 1992). The 1992 Hospitals survey indicated that most hospital executives have yet to attain these competencies. However, according to Gail Warden, president and CEO of Henry Ford Health System, in Detroit schools of hospital administration have begun to produce students in healthcare management fellowships "who are already trained as facilitators, have good exposure to process improvement, are accustomed to being on teams, and are statistically minded. And that's what's going to change the whole culture..." (Eubanks, 1992). While some American companies have begun to abandon TQM (Mathews & Katel, 1992), TQM and CQI can work if healthcare managers and administrators focus on long-term success rather than short-term gains. Management too often expects instantaneous success, but TQM takes time. It is an evolutionary process, not a source of immediate transformation (Ziacik, 1992). A culture cannot be changed over night. Utah's Health: An Annual Review 1993 83 |