RESUMO
The purpose of this project was to determine whether changing clinicians' behaviors to reduce costs in a large academic medical center is facilitated by the prior existence of a total quality management program. Ten teams, made up primarily of clinicians, were charged with devising strategies for altering specific clinical behaviors to reduce costs without detriment to quality of care. Half the teams followed the center's total quality management approach. Team success was assessed by how well three key tasks were completed: problem definition, design of plan of action, and plan implementation. Two teams achieved outright successes, three had outright failures, and five were in between. Adherence to a total quality management approach was not found to be associated with team success. A much better predictor of success was the level of involvement and support by clinicians and managers; because that factor is largely controlled by institutional incentives, those incentives may need to be realigned before the effectiveness of a total quality management approach can be properly evaluated.
Assuntos
Centros Médicos Acadêmicos/normas , Atitude do Pessoal de Saúde , Corpo Clínico Hospitalar/educação , Gestão da Qualidade Total/organização & administração , Controle de Custos , Humanos , Motivação , Política Organizacional , Equipe de Assistência ao Paciente/normas , Técnicas de Planejamento , Resolução de Problemas , Comitê de Profissionais/organização & administração , Estados UnidosRESUMO
Quality experts state that ineffective leadership can hinder and even destroy efforts to implement total quality management (TQM). However, they rarely discuss the specific actions leaders should take in implementing TQM and when leaders should take them. This article discusses a four-phase TQM implementation model that includes specifications for leadership actions at each step.