Applying total quality management in healthcare information systems

Several methods exist for monitoring software development. Few formal evaluation methods have been applied to measure and improve clinical software application problems once the software has been implemented in the clinical setting. A standardized software problem classification system was developed and implemented at the University of Utah Health Sciences Center. External validity was measured by a survey of 14 University Healthcare Consortium (UHC) hospitals. Internal validation was accomplished by: an indepth analysis of problems details; revision in the problem ticket format; verification from staff within the information systems department; and mapping of old problems to the new classification system. Cohen's Kappa statistics of agreement, used for reliability testing of the new classification systems, revealed good agreement (Kappa = .6162) among HELP Desk agents in consistency of classifying problems calls. A monthly quality improvement report template with the following categories was developed from the new classification system: top 25 problems; unplanned server downtimes; problem summaries; customer satisfaction survey results; top problems details; case analyses; and follow-up of case analysis. Continuous Quality Improvement (CQ) methodology was applied to problem reporting within the Office of Information Resources (OIR) and a web-based ticket entry system was implemented. The new system has resulted in the following benefits: reduction in problem resolution times by one third; improved problem ticket information; shift of 2 FTEs from call center to dispatch due to the increased efficiency of the HELP DESK; and a trend in improvement of customer satisfaction as measured by an online survey. The study provided an internal quality model for the OIR department and the UUHSC. The QM report template provided a method for tracking and trending software problems to use in conducting evaluation and quality improvement studies. The template also provided data for analysis and improvement studies. The template also provided data for analysis and improvement of customer satisfaction. The study has further potential as a model for information system departments at other health care institutions for implementing quality improvement methods. There is potential for improvement in the information technology, social, organizational, and cultural aspects as key issues emerge over time. There can be many consequences to the data collected and many consequences of change can be studied.