Using Quality Circles in developing a Quality Culture

Many Quality professionals who have been given the task of implementing NABH standards in their hospitals face this common challenge - "How do I bring about the change? How do I get everyone on board? How can I get everyone's involvement in the standards implementation process? Why is it perceived that quality is only my responsibility and not theirs' too?" These are common experiences that a quality professional goes through. She is confused about what should be the starting point of standards implementation. She cribs about lack of management support and that the staff is non-cooperative.

In an earlier article, I had highlighted that a Quality Culture is a must to ensure the long term success of the quality initiatives. In this post, I will discuss an important tool which will help you create that culture.

We have to start with the basic premise that our staff are not dumb. They are our knowledgeable colleagues who have years of experience and expertise in doing a particular job. We need their help in getting the standards implemented. It is a team effort. Therefore, we have to seek their collaboration. There is a huge potential locked in our manpower and we need to tap into that potential. The way we need to encourage their participation and get them involved is through engaging them in a meaningful discussion, which is open, collaborative, intellectually stimulating and a good value for their time. It is in this context that the concept  of Quality Circles (QCs) comes very handy. We need to understand and implement the essence of QCs.

A QC is a small group formed of the employees of an organization who are supervised by someone senior to them and they identify, analyze and discuss work-related problems and collectively devise solutions to them. The fundamental idea is that our people know the problems and they can also design solutions to those problems. Isn't it simple? The groups in the QC meet during the office hours and are free to discuss any topic they want to discuss related to their work. The supervisor needs to moderate the discussion to ensure that the group invests its time to diagnosing the problem with their collective insights and work together to propose solutions. The management can then decide to pick some of these solutions and suggestions to improve quality standards and organizational processes.

Building a culture of Quality as a pre-cursor to NABH implementation

Many times I am asked questions by administrators and hospital owners regarding the time it would take for their hospital to achieve NABH accreditation. With time I realised that this question presents an opportunity for me to educate them on the culture of Quality. Through this post, I would try to reach out to quality professionals, administrators, hospital managements and other healthcare professionals to involve them into a discussion on Quality culture and its relevance to Indian healthcare industry.

If you look at other quality systems like Six Sigma, Lean, ISO etc., these are mostly a philosophy and then crystallized into a methodology to achieve the desirable goals of the philosophy. The way I see Quality is that it is an approach to achievement improvements and always being concerned with the empty space in the proverbial 'half-filled glass'. A quality-mindset pushes you to devise better ways of doing your regular activities and again iterate to improve upon what we have already achieved.

To build a culture of quality, therefore, it is necessary to inculcate a mindset among all the stakeholders to think creatively and participate in continual improvements in the systems and processes of the organization. when we build such a culture, we are breaking the inertia among the professionals in our organizations and involving them in a participative process of finding better ways of doing things.

Before we delve into NABH implementation, we should first understand that it is also a quality system. Hence, the same fundamentals of building a culture of quality are applicable to NABH implementation as well. Quality professional in any industry would tell you that quality is not a one-day's job; rather it is a life-long striving to achieve perfection in what we do and upgrading the yardsticks by which we measure our performance.

We need to commit to Quality at the highest levels of management, which should trickle down the ranks by the way of goals and measurable objectives to achieve desired performance level. In the absence of the management commitment, it becomes difficult for the system to work coherently. We need to understand that NABH as a quality system is a tool to gear our hospitals towards a culture of making continual improvements every day. The system of assessment and surveillance audits is meant to gauge the compliance of the organization to this culture. The focus on the 64 measurable indicators is meant to give the hospitals a direction in how to measure their performance on quality parameters and to motivate them to improve their performance on these indicators by increased scores over a period of time. The fact that the standards themselves undergo transformation and that we are following the 3rd edition of NABH standards speaks for itself. The standards are responding to the changes happening in the industry and the increase in expectations of the patients from our hospitals. Any hospital planning to go for NABH has to also create systems that will be able to match the pace with which the standards are themselves expanding. To achieve this, therefore, we require a culture of quality in our organizations.

We need to question our existing practices, the way we do things and find out ways to improve them. NABH standards are your guide to ask these questions in a systematic way.

The importance of educating management on NABH standards

Many administrators and quality professionals leading the task of implementing NABH in their hospitals face this one particular issue quite often - lack of management support. While it is the management who has assigned them with the task of implementing NABH, quality professionals find themselves pushed against the wall when their various needs are rejected by the management. Where does the problem lie?

In my assessment, I feel that the hospital owners and the people holding top positions in a hospital make wrong decisions about NABH implementation when they are unaware of the requirements of the standards. Interestingly most people have some kind of opinion regarding NABH standards and when they talk about implementation of standards, they refer to their poor knowledge about NABH standards to make their decisions. It's also been a personal observation that when the management and top people and doctors are trained on NABH standards, they are very clear about what they need to do to achieve certain goals.

I think any NABH implementation process should first start with sensitization of management team and head-of-departments (HODs) or key managers on NABH standards and training them on the complete requirements. Once they have gone through the initial training, they would be better prepared to understand the demands put forth by standards, and accordingly they can see their commitment level to NABH implementation. This would go a long way in simplifying the work of a quality professional.