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Quality leadership in healthcare services: selected papers from 4th Canadian Quality Congress
Edited by Madhav Sinha
1. Introduction
Originally, quality programs merely included activities involving product inspection at the end of the production line in order to detect noncompliance with specifications. With the passing of time, quality control was complemented with root cause analysis and failure prevention activities through the use of statistical tools, thus giving rise to quality assurance. Both quality control and quality assurance were thoroughly focused on fabrication tasks and therefore mainly applicable to product manufacturing companies.
Over the last few decades the unit of analysis of quality programs has shifted from the product to the process, and their scope has widened to encompass every activity that can affect overall effectiveness and customer satisfaction. One of the most well-known quality models that emerged during this period at international level is the ISO 9000 Quality Management System (QMS), which is based on the process approach. According to these standards, organisations should be managed as a system consisting of four cyclic sequential macro-processes: management responsibility; resource management; production or provision; and measurement, analysis and improvement ([4] International Organization for Standardization, 2008). As these new more flexible systems were implemented, quality programs were no longer limited to manufacturing companies but started to be applicable to other industries, such as those providing services.
At the present time, quality programs are evolving towards a philosophy called Total Quality Management (TQM) whose primary objectives are continual improvement and long-term sustainable growth. This concept is based on QMS principles such as effectiveness and customer satisfaction, but also takes into account efficiency and resource optimisation through the use of economic measurement tools such as quality cost.
The purpose of this document is to describe a quality cost model for healthcare services that helps these organisations move towards the TQM concept, taking as a reference the QMS model proposed by ISO 9000 international standards. Nonetheless, there are some factors that make this task difficult. First, "... in most of the world, healthcare organisations and services are operating at or below the stage of quality assurance" ([1] Clinical and Laboratory Standards Institute, 2004) and therefore the use of ISO 9000 QMS is not widespread in this industry. Second, some intrinsic limitations make...