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Application of TQM principles to the utilization management process
Physician Executive
|April 8, 1992
Summary
Total Quality Management (TQM) and Continuous Quality Improvement (CQI) principles applied to utilization management reveal system inefficiencies. Focusing on processes, not individuals, drives significant cost savings and improves patient care outcomes and satisfaction.
Area of Science:
- Healthcare Management
- Quality Improvement Science
- Systems Engineering
Background:
- Healthcare utilization management often faces inefficiencies.
- Traditional approaches may overlook systemic process flaws.
- Quality management philosophies offer a framework for improvement.
Purpose of the Study:
- To explore the application of TQM and CQI to healthcare utilization management.
- To identify systemic sources of inefficiency in inpatient flow.
- To evaluate the impact on patient care outcomes and satisfaction.
Main Methods:
- Adopting a total systems perspective for inpatient flow analysis.
- Reviewing admitting through discharge processes.
- Analyzing system and process failures rather than individual performance.
Main Results:
- Significant and costly inefficiencies stem from faulty systems and processes.
- A detailed review of service delivery processes is required.
- Evaluation of patient care outcomes and satisfaction is crucial.
Conclusions:
- TQM and CQI principles are vital for optimizing utilization management.
- Systemic analysis is key to reducing healthcare inefficiencies.
- Improving processes enhances patient care and satisfaction.