Rx for Hospitals: New Hope for Medicare in the Nineties

Paul G. Thomas is a political science professor at University of
Manitoba and co-author of Canadian Public Administration: Problematical
Perspectives.

This book represents the upbeat message that total quality management
(TQM) and continuous quality improvement can be transferred from the
industrial sector to the hospital sector to produce both improved
service and significant cost savings. The author is the administrator of
St. Joseph’s Health Centre (a 950-bed facility in London, Ontario),
and most of his book describes that institution’s initiative to
introduce TQM. Since hospitals are the largest single location of
spending within the health-care system, any prescription for making them
more efficient and customer-friendly should be welcomed.

Hassen insists that TQM has to be adapted for application within
hospitals (as opposed to manufacturing concerns, where it originated)
and that even in the hospital sector there is no one best way to
initiate the approach; how one starts TQM will depend on the size of the
hospital, its patient mix, and the type of community it serves. At St.
Joseph’s, a great deal of time was spent training employees, and
fostering confidence and commitment. TQM was initiated through small
pilot projects that held some promise of success. Another element of
realism in Hassen’s approach was the recognition that introducing TQM
would lead to conflict. Physicians fought with administrators over the
applicability of the approach to hospitals, and over the potential loss
of professional autonomy; unions were concerned about TQM’s being
simply a cost-cutting exercise that would lead to job losses.

The author touches on all of the familiar components of TQM: planning,
leadership and vision, structural modifications, changes to the internal
climate and culture, work process analysis, teamwork, and, above all, a
focus on quality defined in terms of customer expectations. In addition
to the case study of the St. Joseph’s experience with TQM, the book
includes a roundtable discussion on the topic by hospital administrators
and an appendix of statistical tools to support TQM analysis.

Overall, this is a valuable book that should be widely read by
practitioners for its insights into the process of organizational
change. Two qualifications should be made, however. First, as Hassen
admits, TQM is a continuous process and it is too early to say that St.
Joseph’s has changed permanently for the better. Second, it stretches
credibility to argue that TQM will save medicare, as the title and the
final chapter imply; preserving the best features of medicare will
depend far more on total quality politics and policy than it will on
TQM.