TQM and Physician Involvement

In the case we read about Virgina Mason's use of Toyota's Production System (TPS) and the associated management philosophy of Total Quality Management, which was adopted widely among health care delivery organizations in the early to mid 1990s (p. 5 in case).  Experience with these techniques was mixed, with some observers arguing that TQM was not applied correctly in health care and others arguing that the approach was ill suited to an industry in which the underlying science was based on biology not physics, cause and effect relationships were poorly understood and the primary worker (the doctor) was only loosely affiliated with the organization.

In a 2003 survey by Casalino and colleagues found that even after more than a decade of focus on process improvement, physician groups’ use of the of tools for process management, such as clinical practice guidelines, disease registries, and performance measurement and benchmarking was limited.

One important factor in whether or not TQM gained traction in a health care delivery organization and was effective was physicians’ involvement in hospital governance. The alignment between physicians and the health care delivery organization (defined as “the degree to which physicians and organized delivery systems share the same mission and vision, goals and objectives, and strategies, and work toward their accomplishment”) was an important determinant of whether physicians adopted a range of clinical management practices aimed at improving clinical performance.

We will next read how Intermountain Healthcare changed clinical operations.  As an example of how Intermountain uses lean management strategies, here is a video that gives you an idea of how early attempts at TQM can work today.

L. Casalino, R.R. Gillies, S.M. Shortell et al.,“External Incentives, Information Technology, and Organized Processes to Improve Health Care Quality for Patients With Chronic Diseases,” JAMA (2003), 289, 434-441.