Suggestions on establishing a quality management department for nguyen trai hospital

This thesis presentedthe situation of applying quality management system at Railway ConstructionCorporation JSC and set out some methods of improving the quality managementsystem of the

I

ACKNOWLEDGEMENT

I am taking this opportunity to express my deep gratitude and regards toall people who gave me the possibility to finish this research paper on schedule.First of all, I would like to give my special thanks to my beloved family I mustproudly say I have the most wonderful parents in the entire world Not only theybrought me to this beautiful world but also, they always do their best to assure

my healthy and happy life They are the major reason and motive for me to keep

on working to complete the paper no matter how hard things could possibly be.Without their unconditionally love and nonstop caring, understanding andsupports, I do not think I could make this far

Next, allow me to express my deep appreciation to my advisor, Mrs Tran TuyNga, for her constant instruction, valuable advices, whole-hearted support andencouragement in this research paper Also, I must acknowledge all my lecturers

in HUFLIT for general and in the Department of International BusinessAdministration for particular, who have taught me such valuable knowledge thatplays an important part in my research as the theoretical base

Last but not least, I am also indebted to the members of Nguyen Trai Hospital forthe information provided by them in their own field

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Khoa Quan Tri Kinh Doanh

CONG HOP xA HOI CHU NGHIA VII;:T NAM

Doc L~p - T\T Do - H~nh Phuc

ADVISOR'S COMMENTS Title SUGGESTIONS ON ESTABLISHING A QUALITY MANAGEMENT

DEPARTMENT FOR NGUYEN TR.AI HOSPITAL

Student: Tru'o'ng Le Qu~ Anh

Class: KQII-0l

Advisor : Trh Tuy Nga ,MBA

Student Code: IlDH490103

at offering A quality management department for all hospitals in HCM city in general and

especially Nguy~n Triii hospital to satisfy the need of numerous patients in HCM city

CONTENT

The graduation paper has six chapters

Chapter One : Introduction It is composed of six parts:

I Background of the research

2 Review some previous research

3 Aims of the research

4 benefits of the research

5 Limit of the research

6 Structure of the research Chapter Two Literature Review It is composed of two parts

I.Overview of quality

2 Overview of quality management Chapter Three: An Introduction ofNguy~n Trai hospital It is composed of three parts

1 Introduction 2.0rganizatinnal structure

3 Human resources : Methods and materials : Resu[ts and Discussion : Suggestions

PRESENT AnON

The paper contains 02 tables ,03 figures ,0 2 photos, 01 appendices with relevant notes and References

to tell us how hard and enthusiastic the writer is The paper is well-presented.

GENERAL ASSESSMENT

[n term of applying Department of [nternational Relations knowledge learnt at the university, the writer with ambition and diligence is capable of studying individually and scientifically In the process of completing this graduation she always shows us her self-confidence The paper is really a success at the SA level The presentation is well-illustrated, and the content is arranged logically with rather feasible suggestions I appreciate highly this graduation paper.

SUGGESTED GRADE: Excellent

1-10 Chi Minh City June 9th 20 I 5

TRAN TUY NGA, MBA

I

EXAMINERS' COMMENTS

, ~ .

Realizing the significant roles of quality for healthcare services, this paper1S aimed at giving out some suggestions on how to establish a QualityManagement Department for Nguyen Trai Hospital The research was structuredwith five chapters With chapter one, readers are taken on a quick tour to have anoverview on the research Next is chapter two which provides a literature review

or the theoretical base of the research Chapter three introduces some basicinformation of Nguyen Trai Hospital Then, chapter four presents the methodsand materials used in the research In chapter five, there are discussions about theresults achieved from the primary research (questionnaire) Finally, chapter sixpresents some suggestions on establishing a Quality Management Department forthe hospital

Cha pter 1: INTRO DUCTI 0 N 01

Chapter 2 : LITERATURE REVIEW 05

2.1.1 Definitions of quality and cost of quality 05

2.1.1.1 Definition of quality 05

2.1.1.2 Definition of cost of quality (COQ) 06

2.2.3.1 The planning function 12

2.2.3.2 The organizing function 13

2.2.3.3 The controlling function 13

2.2.3.4 The stimulating function 14 2.2.3.5 The adjusting and coordinatingfunction 142.2.4 Four basic methods of quality maoagement 14

2.2.4.1 Quality inspection 14

2.2.4.2 Quality control 15 2.2.4.3 Total quality control 16 2.2.4.4 Total quality management 16

Chapter 3: AN INTRODUCTION OF NGUYEN TRAI HOSPITAL 28

Chapter 4: METHODS AND MATERIALS 33

5.1 Overloaded situation of Nguyen Trai Hospital 395.2 Healthcare service quality from patients and their

Cha pter 6: SU GG ESTI 0 NS • 46

LIST OF TABLES

Table 2 - Two approaches to improve productivity and quality 59

LIST OF FIGURESFigure 1 - Organizational Structure of Nguyen Trai HospitaL 30

Figure 3 - The Circle of Plan- Do- Check-Act (PDCA) 62

Chapter 1 INTRODUCTION

1.1 Background of the research

One of the most alarming situations that Vietnam has to face nowadays is theoverloaded situation in many major hospitals throughout the whole country.According to statistics from the Ministry of Health, the percentage of patientbeds has increased over the past few years; however, it still does not catch upwith the speed of population growth The statistics also shows that, in 1999, thepercentage of patient beds over ten thousand people were 16.9 beds, and thisnumber has risen to 22.3 in 2014 Meanwhile, Vietnam's population growth ismore than 1 million people per year Besides, the rate of disease tends to increasedue to many reasons, some of which are the harmful impacts of environmentalpollution and the increase of traffic accidents On the other hand, according tomany experts in the field of health care, the main cause of this overloadedsituation is the difference between central and local hospitals in terms offacilities, equipment and healthcare service quality

Nevertheless, not only the local hospitals but also central hospitals need toconcern about the quality of healthcare services nowadays In fact, in the age ofglobalization as present, quality is playing an even greater and more importantrole in any business's existence and development than ever As a result, everybusiness has to ensure as well as continuously improving the quality of productsand services to meet customers' needs better This is a nonstop task in the battlefor survival, and even members of the healthcare industry cannot stand aside.This, as a result, leads to a question - how to improve the quality of health careservices in hospitals?

The answers are varied depending upon each person's point of view However, Isuggest that it is necessary to establish an effective quality management system

step is to set up a Quality Management Department in every hospital Thisdepartment would take the responsibility of building up a quality managementsystem that would gradually improve the quality of healthcare services inhospitals.

1.2 Review some previous researches

There are a large number of studies reported on many subjects related to qualitymanagement; however, I will only review some typical examples as below

The first example I would like to show is a thesis of Dung Duong Thuy (2010).This thesis reported on the real situation and some measures for appropriate andefficient application of quality management in Vietnamese industrial firms.According to the author, product quality had been a weakness that lasted formany years in the past planned economy As the country is aiming at becoming asocialism-oriented market economy, it was critical to emphasize quality ofproducts and services

Another author wrote a thesis in 2012, which researched on the present conditionand some measures to improve the quality management system of administrativeservices in according to ISO 9000 ~ccording to the author, administrativeservice is nonprofit but played an important role in ensuring the economy'sstability and development Therefore, the application of ISO 9000 intoadministration should aim at building an operating system of quality

Many other researchers chose to focus their studies on the quality managementsystem of a specific company For instance, Ngoc Nguyen Thi Bich (2013) wrote

a thesis on the subject of improving the quality management system at RailwayConstruction Corporation JSC according to ISO 9001:2000 This thesis presentedthe situation of applying quality management system at Railway ConstructionCorporation JSC and set out some methods of improving the quality managementsystem of the company Another example is a res.earch of Quy Dao Thi Kim onthe subject of service quality management at HAGL Plaza Hotel Danang This

research showed the real situation of the hotel and presented some measures toimprove the activities of service quality management at the hotel.

In conclusion, there are many studies that focus on many aspects of the qualitymanagement of products and services However, few have researched on thequality of healthcare services and on how to establish Quality ManagementDepartment for hospitals

1.3 Aims of the research

Firstly, this research aims to give readers a close look on quality and quality

management It is a fact that they are important terms, especially for people whowant to improve their profit; however, some people may see them unfamiliar ormay not understand them clearly Therefore, this research will provide readerswith definitions and more information to expand knowledge on the field ofquality and quality management

Secondly, this research could provide readers with an overvIew of thecircumstance of Nguyen Trai Hospital in Ho Chi Minh City at present.Nowadays, it is easy to find information in many articles as well as on theInternet However, the diversity of information could make some peopleconfused Therefore, the information about the current state of Nguyen TraiHospital in this research is summarized in a way that would help readersvisualize the view easier

Finally and also the most importantly, this research focuses on showing aspecific and brief direction on how to establish a Quality ManagementDepartment in hospital from the base Please notice that this is just a direction toset up a Quality Management Department, not a guideline on how to run aQuality Management Department in detail This topic would require furtherstudies

1.4 Benefits of the research

Firstly, the research shows me a closer view on the situation of health care service

in Ho Chi Minh City at present

Secondly, similar to the first aim of the research, the most important benefit I get

from doing this research is that it gave me an opportunity to expand myknowledge on the field of quality management

1.5 Limit of the research

Because of limited time and possibility, this research will only concentrate onhospitals in Ho Chi Minh City Furthermore, since there are a large number ofhospitals in Ho Chi Minh City, I have to narrow down the object of the researchinto one major and famous hospital in Ho Chi Minh City - that is Nguyen TraiHospital

1.6 Structure of the research

The research includes 6 chapters in total

Chapter 1 is the introduction, which gives readers a first look at the research.Chapter 2 will provide a literature review of some terms that are necessary forfurther study as well as to expand knowledge

Chapter 3 gives an introduction on Nguyen Trai Hospital

Chapter 4 presents the method and materials of the research, which also includesinformation about quality evaluation for hospitals in Vietnam

Chapter 5 concentrates on giving a view on healthcare services of hospitals in HoChi Minh City and a specific direction to establish a Quality ManagementDepartment in hospitals

Chapter 6 will present some suggestions for the topic

Chapter 2 LITERATURE REVIEW

In the philosophical viewpoint, quality is the confirmation of a thing or anevent's nature, the characteristic determining that the thing or the event was notsomething else, or based on which the thing or the event could be distinguishedfrom the others According to this viewpoint, the meaning of quality seems soabstract and is hard to understand

With producers, quality means the guarantee to achieve and maintain a collection

of standards, specifications or requirements that was set out before Producersconsider quality as a requirement in order to meet customer needs and gain theiracceptance as well as to compete with competitors in the market A product ofquality must meet the measurement which is appropriate with the system ofstandard

Customers tend to see quality as the product's suitability with the intended uses

Or in other words, quality is the satisfaction of customers Philip Crosby in hisbook named "Quality is free" stated that, quality is the suitability withrequirement Also, Professor Edward Deming defined that, quality is thesuitability with intended use or customer satisfaction This approach of quality is

in accordance with the nature of business Many businesses accept this definition

2.1.1.2 Definition of Cost of Quality (COQ)

In many steps of the process of producing a good or providing a service, money

is one of the most essential factors A good or service gains its competitivenessfrom a balance between two major factors: quality and the costs required toobtain that quality Cost that is required to obtain a quality level must becarefully managed in order to assure and maintain its long-term efficiency.Moreover, these costs serve as an accurate measure of the quality level This, intum, leads to another term - cost of quality (COQ)

The term "cost of quality" was first mentioned by Armand V Feigenbaum in anarticle (Harvard Business Review) in 1956 After that, its definition as well asmany matters around it was given discussions in many researches of many otherexperts in the field of quality, such as Joseph Juran, Edward Deming, PhillipCrosby and so on

Generally, COQ refers to all of the costs that are related to the assurance of aproduct's or a service's quality According to ISO 8420:1999, costs related toquality are costs incurred in assuring that quality is satisfied as well as costsincurred as a result of damages occurring when quality is not satisfied

2.1.2 Relationship between quality and cost

It is essential to see the mutual effect between quality and cost of quality In theprocess of achieving and maintaining the required level of quality, costs areincurred in many aspects such as equipment upgrade, employee training, andtechnology update This leads to two primary issues

The first issue is that costs put more pressures on prices As mentioned above, aproduct or a service is obligated to reach a certain level of quality in order tomeet customer needs and expectations, to gain their trust as well as to competewith competitors' As a result, it brings profit and ensures a continuous andefficient business operation for the company On the other hand, when the costs

of producing a good or providing a service is too great, the company has nochoice but to increase the prices if it still wants to earn some profit

No one can deny the fact that customers prefer buying product and service whichmeets their required level of quality However, many of them might not bewilling to buy a product at a price that they see unreasonable or unaffordable.Then, if a competitor offers the same product, perhaps in a lower quality level,but at a much lower price, what do you think the customers will choose? Youcould still keep your customers, mostly the loyalties but at the same time, youwould lose a number of customers If this high price keeps on rising up, it doesnot take long till the day you finally lose the game

The pressure which costs put on your source of money is the second issue Iwould like to discuss It is obvious that fund is limited while achieving higherquality level requires larger amount of money What would you do if you cannotafford the quality level you wish? Or what would happen if you misjudge andwaste a lot of money for nothing? This may cause a big problem for those whocannot accurately calculate the fund condition as well as the finance situation oftheir company

Those issues may sound contradictory; unfortunately, this is also a cruel truth inthe field of business That is why we need to keep a balance between quality andcost of quality Offering a product or a service of high quality must come alongwith making sure that the cost is reasonable and affordable As the modemeconomy is paying more attention on quality and price competition, balancingbetween quality and the cost to obtain that quality might become a significantcore competence of any company in the fight for survival and success

2.1.3 Necessity of quality

In the age of globalization, competition gets tougher than ever and the increasingnumber of brands gives consumers more choices Also, the widespreaddevelopment of the Internet brings consumers easier access to productinformation With just a single click, they can look for the origin, sources ofmaterials, functions, and prices of any product they want in a detailed way As aresult, the comparison between products of different brands has never beeneasier This is the time when every compan~ must seriously concern onimproving and maintaining product quality

The most primary reason is that quality has been and will always be a crucialfactor which decides the survival and development of any business Famousbrand names, competitive prices, various designs, multi-functions, and so on areimportant factors in attracting buyers and influence their purchasing decisions.However, if reality does not meet expectation, many problems may happen andcan even ruin the company image Building up a castle made of cards takes a lot

of efforts and time, but destroying it would only take a single blow In the end,what actually keeps customers is quality

Therefore, it is not overstated when saying quality is a widely accepted language,the center of attentions and a competitive weapon of any enterprise in thedomestic as well as globally markets It attracts buyers and when the productreaches a stably high level of quality and is able to meet customer needs well, itcould gain customers' trust and build a good company image in their mind.Gradually, buying habit is created That is why quality is considered as animportant condition in gaining trust and enhancing company status in the market.Since the topic of this research is about healthcare services, let's narrow it down

to the necessity of quality of healthcare services in Vietnam's hospitals As theeconomy is gradually shifting towards marketization, the State reduces itsmonopoly on many types of businesses, including healthcare services As aresult, many international hospitals were established in the recent years, andsome typical examples I may name are FV Hospital and Hanh Phuc Hospital

The costs of medical treatment in international hospitals are usually high;however, in return, they bring benefits that public hospitals may not have, such

as advanced medical equipment, skilled team of doctors, professional anddedicated serving style and so on In order words, international hospitals offerpatients healthcare services at a higher level of quality As living standards arerising, people begin to appreciate quality over cost, and some of them are willing

to pay more for better services This is the time when public hospitals shouldconcern more about quality of healthcare services in order to build good image inclients and patients' minds Only then, they would be able to compete withinternational hospitals in the market economy, where low price is not enough towin the battle

2.2 Overview of quality management

2.2.1 Definition of quality management

Quality is not naturally born; actually, it is the result of the impact of a series ofclosely related factors In order to achieve the required quality level, propermanagement of these factors is in need Quality management is an aspect ofadministrative functions to determine and implement strategies on quality controland improvement

Therefore, in general, quality management is a set of managerial activities in thefield of quality At present, there are many perspectives on quality management

A G Robertson, a British specialist of quality, defined quality management as amanagerial system that aimed at developing programs and coordination of efforts

of various units to maintain and enhance quality in design and production thatcan ensure production efficiency and satisfy customer need at the same time.Also, A V Feigenbaum, an American scientist, stated that quality management

is a unified and effective operating system of different departments within anorganization (an economic unit) This system takes the responsibility ofdeploying quality parameters, maintaining the achieved quality level and

enhancing the quality level to ensure economical production and consumption ofproduct as well as to satisfy consumer demands.

The International Standard Organization (ISO) also mentioned in ISO 9000 thatquality management is a managerial activity that sets targets and policies ofquality and then implements them by methods such as quality planning, qualitycontrol, quality assurance and quality improvement within the framework of acertain quality management system In many documents of ISO 9000, the target

of satisfying customer needs is emphasized

2.2.2 Principles of quality management

Quality management is a managerial field with its own characteristics Whenimplementing quality management activities, managers should adhere to thefollowing principles

(1) Quality management must ensure the customer orientation

In the market economy, customers are the ones who set out requirements forproduct quality and price, not businesses Therefore, a company must createproducts which are able to gain customer acceptance and consumption in order tosurvive and succeed

(2) Human factor must be concerned seriously

To build a good quality management system, human factor is a matter that anyenterprise cannot underestimate Human takes an important role in the entireprocess of building and maintaining quality Therefore, in quality management, it

is necessary to apply appropriate methods to use full capacity of the resourcesand talents of people into maintaining and increasing quality

Managers should set an good example for employees They must be aware oftheir staffs capabilities and how to encourage them to work efficiently forcommon goal of achieving corporate quality

Employees or workers are the ones who directly implement the tasks formaintaining and increasing quality Besides, employees also give feedbacks and

ideas for quality improvement to managers A good cooperation betweenmanagers and employees will create good results and help increase the qualitylevel of the company and at the same time reduce any unnecessary cost incurred.(3) Quality management must be comprehensively and uniformly implemented.Quality is a result of the entire process of market research, quality policyestablishment, product design and development, post purchase services and so

on It is also a result of joint efforts of managers and employees, departments,suppliers, and more That is why maintaining and enhancing quality requirescomprehension and synchronization Unilateral decisions in solving problemsrelating to quality management would not bring the desired results

(4) Quality management must be implemented simultaneously with therequirements of quality assurance and improvement

Quality assurance and quality improvement are closely related Quality assuranceconsists of maintaining and improving quality to meet customer needs Qualityimprovement includes maintaining quality and increasing efficiency andeffectiveness of quality to satisfy customer needs better Maintaining andimproving quality is a continuingly developing task of quality management Inorder to survive and develop in competition, businesses must assure quality at thesame time with constantly improving it

(5) Quality management must assure the process

In reality, businesses are using two widely known types of quality management.With the first type, Management by Process (MBP), quality management isneeded in every stage related to the establishment of quality In contrast, thesecond type, Management by Objectives (MBa), businesses focus on the end, orthe desired result, over the process of creating that result However, in thebeginning stage of development, MBP may be considered more appropriate

(6) Quality management must adhere to the principle of inspection.

Inspection is a very important part of any managerial system Without checking,

it would be hard to know how well the work has been performed Withoutchecking, works could not be completed, and there would not be progress.Similarly, in quality management, inspection aims at limiting and preventingerrors, finding out measures to overcome bottlenecks, promoting the strengths,and assuring and increasing quality to meet the market demand

2.2.3 Basic functions of quality management

Similar to the other managerial activities, quality management reqUIresimplementation of some basic roles such as planning, organizing, controlling,stimulating, and coordinating However, since quality management has itsparticular targets and objects, its functions also have particular characteristics

2.2.3.1 The planning function

Planning is the most crucial functions and must be taken before the others.Planning refers to the action of determining objectives, means, resources andmethods to achieve the goals of product quality

Planning consists of three main missions The first mission of planning is toresearch on the present or potential market to determine customer needs andspecify the technical parameters of products or services The second missionrequires setting up the quality targets needed to achieve and the policies forcorporate quality The final mission is to pass the planning results along to thefunctional departments

With the planning function of quality management, company is fable to set thedirection of quality development for the whole company Moreover, planningcreates possibilities for the company to increase its competitiveness in the market

as well as to positively enter and expand the market And last but not least, withplanning, enterprises can effectively exploit their resources and potentials on thebasis of reducing the cost of quality

2.2.3.2 The organizing function

The main missions of this function include the followings

(I) Organizing a system of quality management:

At present, there are many systems of quality management such as Total QualityManagement (TQM), ISO 9000, Hazard Analysis and Critical Control Points(RACCP), Good Manufacturing Practice (GMP), and so on Every businessshould choose an appropriate system for its own

(2) Organizing the implementation of conducting economic, organizational,technical, political, and administrative measures to complete the plan set outbefore

This mission requires that every person who takes part in the plan must clearlyunderstand the objectives, the importance and the exposure of his/her job Also,company should organize training programs for those who implement the plan aswell as providing necessary resources at anytime and anywhere

2.2.3.3 The controlling function

Quality control is the process of controlling and appraising performances bytechniques, means, methods and activities in order to assure that quality followsthe requirements The main missions of controlling are as followings

(l) Organizing activities to create products that are able to meet the requiredquality

(2) Appraising the quality implementation of the company in reality

(3) Comparing real quality with planned quality to discover the differences

(4) Conducting necessary actions to overcome differences to assure properlycompleting the target

2.2.3.4 The stimulating function

Stimulating the assurance and improvement of quality can be achieved throughthe application of rewards or punishments on employees and national rewards ofquality assurance and improvement

2.2.3.5 The adjusting and coordinating function

This function includes all activities done for the purpose of creating asynchronized cooperation and overcoming the existing errors to bring qualityinto a higher level As a result, it helps businesses satisfy customer needs in amuch better way

For quality management, adjusting and coordinating activity is all about qualityimprovement, which is conducted in several directions Quality improvementfocuses on either product development and diversification, or technologyupgrade, or complete change and improvement of the whole production process

to reduce errors

During the process of adjusting quality, it is necessary to clearly understand thedifference between eliminating the errors and eliminating the causes of thoseerrors For examples, a specific type of toys produced by company X failsmeeting the required level of quality In this situation, using many methods to fixthe products is an action of error elimination This will only work for a shorttime, and the best option is to find out the causes of this failure

2.2.4 Four basic methods of quality management

There are many methods for quality management; however, m this researchpaper, I would only present briefly four ofthem The four methods I am going todiscuss below are the most basic and traditional ones

2.2.4.1 Quality Inspection

The Quality Inspection is very common method in assuring that products meetthe requirements by physically testing them Through the examination,

disqualified products are screened and eliminated so that the remains are thosewhich met the required specifications as well as the technical parameters.

In definition, Quality Inspection refers to the actions of measuring, examining,testing, and setting the level of one or more characteristics of the subject thencomparing the results with needs to determine suitability of each characteristic.Nevertheless, since the early 20th century, production in large quantity is widelydeveloped In addition, with increasing needs for quality of customers, businesses.

do not only compete over prices any more, but also have to compete over quality

to win more customers and as a result, earn more profits This is the situationwhen every manufacturer needs to realize that, Quality Inspection cannot servethe best anymore

In fact, Quality Inspection simply classifies products which are already made Inorder words, it deals with "what has been done" Besides, according to themodem definition of quality, quality is made during the whole process ofproduction Testing simply eliminates disqualified products, not making thequality of the products Therefore, this method may be considered less cost-effective

That led to the appearance of a new method - the Quality Control (QC)

Primarily, these controls are aimed at preventing production of disqualifiedproducts In general, Quality Control means taking controls over humans,methods, processes, inputs, equipment, and finally is the environments

Quality Control was first issued in the U.S.; however, this method was mostlyapplied in the field of military and was not brought into play after war by manyAmerican companies On the other hand, Quality Control is well applied anddeveloped in Japan, which is gradually absorbed into the country's culture

2.2.4.3 Total Quality Control

So far, Quality Control is applied in the limit of production and inspection.However, in order to achieve the main targets of quality management - that is, tosatisfy customer needs - applying Quality Control only in the processes beforeproduction, such as market research, R&D, planning, development anddesigning, is not enough Quality Control must also be applied in the processesafter production; for examples, packaging, storing, delivery, distribution andselling as well as post-purchase services This controlling method is called TotalQuality Control (TQc)

According to Feigenbaum, Total Quality Control is defined as an efficient systemthat brings together development efforts, as well as maintaining and improvingquality of different groups into an organization so that the activities of marketing,techniques, production and services can be conducted in the most economicalway that could possibly satisfy customers

Total Quality Control mobilizes efforts of every unit of the company intoprocesses relating to maintaining and improving quality This allows maximumsavings from production and at the same time satisfying customers

2.2.4.4 Total Quality Manage~ent

In recent years, the development of new administrative techniques, such as JIT(Just in time) system, has provided a theoretic basis for Total QualityManagement (TQM) Total Quality Management was originated in someEuropean countries in the 1950s and has steadily become more popular since theearly 1980s

Total Quality Management is defined as a quality-oriented managerial approach

of an organization Its basis requires the involvement of all members of the

organization for the main purpose of long-term success by satisfying customerneeds as well as benefits of the organization's members and the society.

Based on the definition, it can be seen that the most primary target of TotalQuality Management is to improve product quality and satisfy customers asmuch as possible One outstanding characteristic of Total Quality Management incomparison with previous methods of quality management is that it provides acomplete system for administrative and improving activities in every aspectrelated to quality Moreover, Total Quality Management helps mobilizeparticipation of every unit and every person to achieve the objectives of qualitythat were set out

Another difference that Total Quality Management has as compared with othermethods is that it views an organization as a collection of processes It maintainsthat organizations must strive to continuously improve these processes byincorporating the knowledge and experiences of workers To be simple, TotalQuality Management aims at "do the right things, right the first time, everytime",

In reality, there are many companies that have successfully applied the method,some examples of which are Ford Motor Company, SGL Carbon, Motorola andToyota Motor Company Depending on each company, the systems of TotalQuality Management are operated differently However, they all share the samebasic principles

(1) Quality is the number one priority

(2) Quality is customer-oriented

(3) Quality must be continuously improved

(4) Management must base on human moral

(5) Comprehensiveness must be assured during the quality management process.(6) Quality management requires participation of all units and all employees

(7) Scientific methods should be used such as statistic techniques, JIT, etc.

Besides, according to John S Oakland, to conduct a system of Total QualityManagement, many companies must share the following steps Depending on thereal conditions of each business, these twelve steps could be divided into smallersteps or added up to others for easy arrangement of times

Step 1: Understanding quality

The process of understanding and committing to quality can be paired with eachother In addition, this process serves a~ the foundation for the entire structure ofthe system of Total Quality Management Especially, it requires theunderstanding and commitment of the top managers In many cases, this also isthe first and primary step to conduct programs for quality management, evenunder any model

To be honest, many organizations has underestimated and skipped this step Onthe other hand, in order to understand quality in a scientific and systematic way,

a new approach on managerial styles and skills for employee encouragement isrequired to build the base for implementation of quality activities Knowledgeshould be expressed by targets, policies and strategies for commitment of theleadership Moreover, a strategy for implementing Total Quality Managementmust be proposed By taking full advantage of skills and creativity of the entireemployees, the strategy is aimed at continuously improvement of processes andoperations to achieve strategic targets of the business and to satisfy customerneeds

Step 2: Committing to quality

There are three levels of commitment: commitment of top managers,commitment of middle managers and commitment of employees

Firstly is the commitment a/top managers.

This commitment plays an important part in creating a favorable environment foractivities of quality in the organization Also, it represents their concern and

responsibility towards activities of quality From that point, it leads everymember of the organization to positively participate in the quality programs Thecommitment should be expressed clearly through the quality policies of theorganization.

Secondly is the commitment of middle managers.

This commitment is aimed at assuring development of quality programs indepartments and units As middle managers are the ones who act as a bridgebetween top managers and employees, their commitment is an important catalyst

in many activities of quality management

In the reality of Vietnam, when employee skills still have many deficiencies, therole of middle managers is extremely important Their tasks are not onlychecking, controlling but also including training and instructing activities ofquality improvement in the company They would need delegation of power ofdirectors to actively solve issues emerging in production That is why theircommitment will create good condition for activities of quality groups in theworkshop

Finally is the commitment of employees.

Employees are the primary force of quality activities Performance results ofTotal Quality Management depend greatly on the commitment of the members ofdepartments and workshops in the company If they do not commit to quality ineach job, the efforts of the above managerial levels may not achieve the desiredresults

Step 3: Organizing and allocating responsibility

In order to assure the implementation, Total Quality Management requires amodel of cross-functional management The activities of all departments in theorganization must surpass the sections and functions to reach the whole process

in order to exploit total power of them by comprehensively and effectivelyplanning and coordinating

Based on the objectives and policies, the allocation of responsibility must beclear in the structure of leadership and functional departments to guarantee thatevery section of quality activities operates thoroughly all the time.

Allocating responsibility is implemented according to the three levels as below

• Top managers are not directly involved in the production; however, they havegreat effect on the performance efficiency of the whole system The superiors

of Quality Management Department take the responsibility to propose andcoherently direct the quality policies to everyone, even to superiors from thehighest levels of the organization

• First-level inspectors are in charge of monitoring the performance of qualityactivities in the organization In other word, they are called in-place practicalobservers They have conditions to seize the practical performance, positive

or negative development of both suppliers and customers; then from thatplace, they take some actions to affect the adjustment

• Members of the system are the center of Total Quality Management Asmentioned above, the most primary target of Total Quality Management is toinduce participation and build trust, attachment, incentives to encouragecreativity of employees Therefore, in order to conduct Total QualityManagement, it is necessary to Build a long-term strategy orienting tohumans, including training, educating, delegating, encouraging on the basis offrequent education as well as social responsibility and awareness

In the entire program of Total Quality Management, every function and task must

be written in documents which specify clearly the objectives of activities in thequality system Also, every function requires incentives and supply of adequatetools and responsibility as well as power for quality management

Step 4: Measuring quality

Quality measuring in Total Quality Management refers to quantitative excess ofefforts on improving and perfecting quality as well as cost of quality in thesystem If we notice the criteria of cost and efficiency, we could realize that thefirst benefit to be achieved is a decrease in costs for quality In statistics, these

costs make up 10 per cent of sales revenue, which reduces performanceefficiency of the company.

In addition, to achieve the target of reducing cost of quality, it needs more thanjust commands from the leadership In fact, it is conducted throughcomprehensive processes of quality management with knowledge and awareness

of every member of the organization In Vietnam at present, these kinds of costsare not calculated properly and separately into a particular part among the entirecosts of the company Because of this, companies are not able to realize theeconomic losses caused by low quality That is why the matter of quality is notconsidered appropriately

In order to attract care and commitmf:nt for quality, it is necessary to have aparticular method of entering in the accounts for these costs The proper andenough determination of these costs could create attention of every membertowards quality Especially, it also creates care of leaderships over theirresponsibility in the programs of quality improvement

Step 5: Forming quality

The task of forming quality is an important function in implementation of qualitypolicies which was issued It includes activities of setting out quality objectivesand requirements, as well as requirements on application of qualitative factors.This task involves the primary issues as below

• Set out plans for products

• Set out plans for administration and tlemonstrator

• Set out strategies, projects and propose processes of quality improvementStep 6: Designing quality

Quality design is a crucial task It is not merely activities in good and servicedesign, but also activities of designing and organizing a process which satisfiescustomer requirements

The precise and scientific organization of design bases on both inner and outerinformation as well as the company's capabilities It has great effects on results

of activities on quality management and improvement Quality design includesthe basic activities as followings

• Research refers to market research and other researches for the purpose ofdeveloping new techniques, methods or processes to improve productivity,quality and to satisfY higher needs of customers

• Development involves researches to improve and perfect matters of thepresent techniques, methods or processes to efficiently, economically andeffectively exploit the company resources

• Designing means set out the product features and specifications so that theycould meet customer needs in an appropriate form with the conditions ofdemonstrator and production as well as the characteristics when exploit anduse the products

• Design appraisal alms at assuring that the design process could meet thedesired objectives in the best way

Step 7: Establishing quality system

In Total Quality Management, quality system should properly describe necessaryprocedures in order to achieve objectives of quality All of the procedures in thesystem should be expressed in "Quality Manual" of the unit The development ofthe "Quality Manual" is an essential job to keep track of the activities that arerelated to quality

Thanks to the advancement of information technology, the quality system cannow be digitalized, which assures that every section of the company'sperformance could be implemented systematically and scientifically The resultswould increase the implementing efficiency of the motto "do it right and do itgood at the beginning", avoid failures a~d reduce costs to the lowest level

However, there is a fact that a quality system cannot bring any benefit by itselfwithout voluntarily and actively participation of all members in the organization.Therefore, in order to succeed, a quality system needs to be built properly and

suitably with the situation as well as the field of action of each company and itsenvironments At the same time, the quality system must comprehensivelycoordinate with the existing systems as well as systems which are going to beestablished in the company On the other hand, it should be built with theparticipation of members so that everyone could understand clearly the qualitysystem of the company.

The procedures of quality system establishment should concern the followingpoints

• A system for files and documents of quality and prepare plans of qualityshould be built

• It is required to determine necessary means in every aspect in order to achievethe desired quality

• A quality measuring system is needed

• It is essential to define the standard specifications which are acceptable for all

of the requirements of products and tasks in the entire process

• A harmony between activities from conceptions, implementation, andorganization of production and installation should be assured

• It is needed to determine and prepare different means to record everythingthat is related to quality

In the process of operation, the quality system is still in need of regularinspection, monitor and improvement With some products and due to customerrequirements, the quality system needs to be certificated to prove the possibilityand conformation towards methods in assuring quality

Step 8: Monitoring through statistics

In order to achieve objectives of quality management and improvement, TotalQuality Management requires nonstop improving the process by monitoring andreducing its fluctuation in order to:

• Determine the capability to meet the process's requirements

• Figure out causes of fluctuations in the process so that the same would nothappen again and build preventive methods.

• Conduct methods to properly adjust the process or its inputs when problemsrelated to quality emerge

Step 9: Examining quality

Quality examination in Total Quality Management is an action related toproduction It inspects not only the product quality but also the quality ofcomponents, semi-finished products, and materials as well as conditions massuring quality

The definition of inspection in Total Quality Management can also be understood

as controlling It is not simply a technical job but also includes synthetic andsynchronous methods about organization, economy, education, administration,and so on The measurement of inputs, outputs as well as the process and thesystem itself is an important section of Total Quality Management for thepurpose of eliminating or controlling causes of quality errors and problems in thesystem Also, on that basis, it implements many activities to improve, enhanceand perfect quality

The quality inspection should be conduct in the following periods

Firstly, quality should be tested before the production.

• Checking the condition of quality and the supply of design and technologicaldocuments

• Checking the condition of measuring and analyzing tools

• Checking the condition of technological equipment

• Checking other conditions of assuring quality

• Checking quality of materials and input products

Secondly, quality should be inspected during the production.

• Checking product consumption

• Checking waste prevention

• Counting and analyzing quality specifications

• Counting and analyzing forms and sources of product disability and problems

in the process

Finally, it is required to excess quality during the using period.

• Using different forms of testing for different environments and different usingconditions to appraise and improve quality

• Surveying customers by holding referendums, customer conferences,answering customer mails, executing statistics, and keeping track ofcustomers

Different from traditional methods of quality management, in a system of TotalQuality Management, quality inspection is primarily conducted by the workersand employees who actually take part in the process This leads to a new way ofthinking in production: Every employee would actively check on theirperformance results Therefore, in Total Quality Management, it is necessary toencourage and train members of the system to apply methods of self-management, self-appraisal and cooperation

Step 10: Group cooperation

Group cooperation in quality activities has a great meaning to organizations This

is simply because the great efforts of a particular person in an organization couldhardly achieve the perfection in resolving problems in comparison with acooperation of many people Therefore, the form of group cooperation couldbring great efficiency in quality improvement, especially in the process ofapplying Total Quality Management The spirit of group coordination spreadingwidely in every organization is a crucial part to implement Total QualityManagement However, it does not mean that the personal role should beovershadowed and in contrast, it is able to develop even stronger

In order to achieve this, the organization must create conditions for each member

to realize their own as well as their group's responsibility This could be done by

contribution, opInIOnS, or their begi~ing efforts That spirit of responsibilitydevelops pride and satisfaction with jobs and better performance Groupcooperation is built from trust, freedom to exchange ideas and especially fromthe understanding of members over general objectives and plans of the company.Step 11: Educating and training on quality

For members of the system to take part in quality management and improvement,

it is essential to organize specific training programs Moreover, these programsneed regular implementation with plans in order to meet the changes oftechnology as well as to adapt quickly to increasingly diversified demand of themarket

On the other hand, application of Total Quality Management requiresstandardization of every factor in the production process The tasks of qualitychecking and appraisal require usage of statistic tools Activities need to becalculated comprehensively and with specific plans so that training on quality is

• What should be done to help employees understand customer's requests?

• Which fields need priority to improve?

• Setting up plans of human resources for the long term and prepare for thefuture

• Which extra procedures and standards need to be proposed?

Training needs to be done regularly to any member of any level In theorganization

• Top managers are the ones who make decisions about policies and strategies;therefore, their deeply understanding about Total Quality Management plays

a big part in deciding if the program would succeed or fail

• Middle managers are the ones who make decisions about tactics or implementthe policies The aim of training for this level is to help them aware of andhave determination to conduct the method of quality which is appropriate tothe proposed objectives.

• Quality inspectors and leaders of quality groups are people who check,monitor and decide in-place works They need well preparation of knowledge

to manage quality activities right on the spot

• Employees of the company are the ones implementing activities of quality.Therefore, each one of them needs to be trained carefully about theprocedures, quality standards related to the jobs as well as techniques,specialist skills and definitions of synchronism in the system They also needs

to have a good understanding over customer requirements from both insideand outside of the company as well as be able to use statistics charts andencouraged to take part in projects of quality improvement

In conclusion, from many real experiences, it can be said that the results ofquality improvement activities for the entire' company could bring someadvantages as below

• Thank to constant quality improvement, the company could enhance itsreputation in the market and stably increase profits by providing customerswith satisfying goods and services

• In the company, regularly improving quality could comprehend efforts ofstaffs, lead their participations into improvement activities, synchronouslyincrease quality and create a well-balanced operating system

• In the process of implementing Total Quality Management, the analysis ofproduction process and quality by statistic tools allows more accurateresearches on results and their causes

• Wide application of Total Quality Management is a firm base to acquire,manage and improve technologies for the purpose of improvingcompetitiveness of products in many aspects

On April 17th 2014 through Decision No 4045/QD-UBND, HCM CityDepartment of Health recognized Nguyen Trai Hospital as first-class hospital Inorder to earn this achievement, Nguyen Trai Hospital, as well as other hospitals,

is evaluated through 5 groups of criteria, which are (1) functions and duties, (2)scope and content of operations, (3) labor structure and staff qualifications, (4)professional qualifications and quality efficiency, and (5) infrastructure andequipment In addition, with the number of more than 800 beds, Nguyen Trai isone of a small number of hospitals which are able to ensure that no inpatientmust share a bed With skilled, experienced. and caring staff, Nguyen TraiHospital upholds a very meaningful motto: "Always dedicate to patient carewith compassion, honor and respect for human rights."

Address: Nguyen Trai Hospital, 314 Nguyen Trai Street, Province 8,

District 5, Ho Chi Minh City, VietnamTelephone number: (08) 39 235 020 or (08) 39 235 926

Official websites: bvnguyentraicdt.com

3.2 Organizational structure

Nguyen Trai Hospital arranges its organization in a quite reasonable three-levelstructure On the top level is the direct~r and the second level is the three deputydirectors The third level comprises four groups of departments, which are (1)functional departments, (2) clinical faculties, (3) paraclinical faculties, and (4)other faculties

Figure 1 on next page illustrates the organizational structure of Nguyen TraiHospital in three layers