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Quality of Long-Term Care - Future Approaches

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Total quality management (TQM) represents a major new approach to managing long-term care. TQM is the integration of a customer-focused, continuous-improvement philosophy, analytical skills, people skills, and a structure and organization within an internal and external culture (organizational or corporate culture which represents the values and beliefs of the organization) driven by leadership. The uniqueness and power of TQM is the integration and balance of the different components, not in the use of its individual parts. Moreover, TQM is grounded in a philosophy of meeting and exceeding customer-defined requirements and working for continuous improvement.

Recent work on quality has identified five principles that are applicable to quality efforts in long-term care:

  1. Providers must know their customers. Quality improvement suggests that organizations have a range of customers. It is essential for agencies to recognize the many different customer groups that they serve. In long-term care, important customer groups such as home-health or nursing-home aides are often ignored.
  2. Providers must listen to consumers. Quality improvement indicates knowing what consumers want and how they feel about the long-term care service delivered is an essential ingredient in achieving quality.
  3. Information is essential for good decision making. For many agencies, basic information about the service recipients, costs, and outcomes of care are simply not available. Quality improvement suggests that agencies must be able to use systematic information to make decisions.
  4. The group is smarter than the individual. This principle states that, in the problem solving and improvement process, a group, in this case, a group of individuals involved in the delivery of service, will make better decisions than an individual, and therefore must be involved in changing the way care is delivered.
  5. Suboptimization is a key challenge facing organizations. Suboptimization occurs when one unit maximizes its efficiency at the expense of other units within the organization. Rather than having individual department or unit goals, agencies need to have a common goal—quality long-term care service.

Implementing total quality principles requires a clear commitment to continuously improving the quality of services delivered. Such programs are not easy to develop, but without a solid approach to involving consumers in the quality process, it is difficult to achieve the quality goals desired by providers and consumers.




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