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A scoping review of continuous quality improvement in healthcare system: conceptualization, models and tools, barriers and facilitators, and impact
Background
The growing adoption of continuous quality improvement (CQI) initiatives in healthcare has generated a surge in research interest to gain a deeper understanding of CQI. However, comprehensive evidence regarding the diverse facets of CQI in healthcare has been limited. Our review sought to comprehensively grasp the conceptualization and principles of CQI, explore existing models and tools, analyze barriers and facilitators, and investigate its overall impacts.
Methods
This qualitative scoping review was conducted using Arksey and O’Malley’s methodological framework. We searched articles in PubMed, Web of Science, Scopus, and EMBASE databases. In addition, we accessed articles from Google Scholar. We used mixed-method analysis, including qualitative content analysis and quantitative descriptive for quantitative findings to summarize findings and PRISMA extension for scoping reviews (PRISMA-ScR) framework to report the overall works.
Results
A total of 87 articles, which covered 14 CQI models, were included in the review. While 19 tools were used for CQI models and initiatives, Plan-Do-Study/Check-Act cycle was the commonly employed model to understand the CQI implementation process. The main reported purposes of using CQI, as its positive impact, are to improve the structure of the health system (e.g., leadership, health workforce, health technology use, supplies, and costs), enhance healthcare delivery processes and outputs (e.g., care coordination and linkages, satisfaction, accessibility, continuity of care, safety, and efficiency), and improve treatment outcome (reduce morbidity and mortality). The implementation of CQI is not without challenges. There are cultural (i.e., resistance/reluctance to quality-focused culture and fear of blame or punishment), technical, structural (related to organizational structure, processes, and systems), and strategic (inadequate planning and inappropriate goals) related barriers that were commonly reported during the implementation of CQI.
Conclusions
Implementing CQI initiatives necessitates thoroughly comprehending key principles such as teamwork and timeline. To effectively address challenges, it’s crucial to identify obstacles and implement optimal interventions proactively. Healthcare professionals and leaders need to be mentally equipped and cognizant of the significant role CQI initiatives play in achieving purposes for quality of care.
Journal Article
Juran's quality essentials : for leaders
\"Dr. Juran's life work on quality--boiled down to a concise guide to creating a strong, successful, globally competitive enterprise Dr. Joseph Juran was a true visionary in the field of quality, and his words continue to inspire. One of his main mantras was \"Take care of the quality, and the rest will take care of itself.\" This work is devoted to just that--taking care of the quality. In it, the Juran Institute team presents the leadership values, beliefs, and actions of top companies, and identifies the strategies that have resulted in measurable success. Juran's Quality Essentials offers succinct, field-tested methods applicable to any industry, from service to manufacturing, and includes realistic timetables of implementation. This unique resource describes three universal quality management methods: 1. designing innovative products and services; 2. creating breakthroughs in current performance; and 3. assuring repeatable and compliant processes. Reveals how to align quality goals and methods to a company's strategic plan Provides a transformation model and roadmap Demonstrates how executive leadership is the key to a company's quality revolution--and how to make quality happen. Filled with insider tips for staying adaptable and using a benchmark to sustain performance Shows how to apply planning, control, and improvement to quality leadership for competitive advantage \"-- Provided by publisher.
Book
How can we recognize continuous quality improvement?
Objective. Continuous quality improvement (CQI) methods are foundational approaches to improving healthcare delivery. Publications using the term CQI, however, are methodologically heterogeneous, and labels other than CQI are used to signify relevant approaches. Standards for identifying the use of CQI based on its key methodological features could enable more effective learning across quality improvement (QI) efforts. The objective was to identify essential methodological features for recognizing CQI. Design. Previous work with a 12-member international expert panel identified reliably abstracted CQI methodological features. We tested which features met rigorous a priori standards as essential features of CQI using a three-phase online modified-Delphi process. Setting. Primarily United States and Canada. Participants. 119 QI experts randomly assigned into four on-line panels. Intervention(s). Participants rated CQI features and discussed their answers using online, anonymous and asynchronous discussion boards. We analyzed ratings quantitatively and discussion threads qualitatively. Main outcome measure(s). Panel consensus on definitional CQI features. Results. Seventy-nine (66%) panelists completed the process. Thirty-three completers self-identified as QI researchers, 18 as QI practitioners and 28 as both equally. The features 'systematic data guided activities,' 'designing with local conditions in mind' and 'iterative development and testing' met a priori standards as essential CQI features. Qualitative analyses showed cross-cutting themes focused on differences between QI and CQI. Conclusions. We found consensus among a broad group of CQI researchers and practitioners on three features as essential for identifying QI work more specifically as 'CQI.' All three features are needed as a minimum standard for recognizing CQI methods.
Journal Article
Industry 4.0, quality management and TQM world. A systematic literature review and a proposed agenda for further research
PurposeThe main purpose of this paper is to analyse the current literature situation in terms of relationships between Industry 4.0 and quality management and TQM. The author wanted to understand what topics and issues can be considered the most relevant referring to the so-called Quality 4.0, what the literature is missing opening avenues for further research.Design/methodology/approachThis research employed a systematic literature review. In total, 75 papers from different sources were reviewed using specific inclusion and exclusion criteria.FindingsFour categories of topics emerged, namely: creating value within the company through quality (big) data, analytics and artificial intelligence; developing Quality 4.0 skills and culture for quality people; customer value co-creation; cyber–physical systems and ERP for quality assurance and control. This paper also tried to understand if there is a definition of Quality 4.0 based on determined methods.Research limitations/implicationsSystematic literature review could have introduced some limitations in terms of the number and reliability of reviewed papers. Probably some interesting papers had been not intentionally missed.Practical implicationsConsultants and managers in developing and implementing their own Quality 4.0 models could use many practical and discussed implications concerning I4.0 technologies and quality management.Originality/valueThis is one of the first papers which employed the systematic literature review for researching Industry 4.0, quality management and TQM relationships.
Journal Article
Quality 4.0 transition framework for Tanzanian manufacturing industries
PurposeThis research aimed at developing the Quality 4.0 transition framework for Tanzanian manufacturing industries.Design/methodology/approachThe survey method was used in this study to gather practitioners' perspectives. The approach included open-ended and closed-ended structured questionnaires to assess respondents' perceptions of Quality 4.0 awareness and manufacturers' readiness to transit to Quality 4.0. The study's objective was to adopt non-probability and purposive sampling strategies. The study focused on fifteen Tanzanian manufacturing industries. The data were analysed qualitatively and quantitatively using MAXQADA 2020 and Minitab 20 software packages, respectively.FindingsThe study demonstrated a high level of awareness of Quality 4.0 among Tanzanian manufacturing industries (i.e. 100% in Quality 4.0 traditional attributes and 53% in Quality 4.0 modern attributes). Individuals acquire knowledge in various ways, including through quality training, work experience, self-reading and Internet surfing. The result also revealed that most manufacturing industries in Tanzania use Quality 3.0 or a lower approach to manage quality. However, Tanzanian manufacturing industries are ready to embrace Quality 4.0 since practitioners are aware of the concepts and could see benefits such as customer satisfaction, product improvement, process and continuous improvement, waste reduction and decision support when using the Quality 4.0 approach. The challenges hindering Quality 4.0 adoption in Tanzania include reliable electricity, high-speed Internet and infrastructure inadequacy to support the adoption, skilled workforces familiar with Quality 4.0-enabled technologies and a financial set-up to support technology investment. Moreover, the study developed a transition framework for an organisation to transition from traditional quality approaches such as quality control, quality assurance and total quality management to Quality 4.0, a modern quality approach aligned with the fourth industrial revolution era.Research limitations/implicationsThe current study solely looked at manufacturing industries, leaving other medical, service, mining and construction sectors. Furthermore, no focus was laid on the study's Quality 4.0 implementation frameworks.Originality/valueThis is probably the first Quality 4.0 transition framework for Tanzanian manufacturing industries, perhaps with other developing countries.
Journal Article
Industry 4.0 as a Key Enabler toward Successful Implementation of Total Quality Management Practices
Industry 4.0 refers to the new technological development occurred at the industrial production systems. It evolved as a result of integrating Internet of Things, Cyber-Physical Systems, Big-Data, Artificial Intelligence, and Cloud Computing in the industrial systems. This integration aided new capabilities to achieve a higher level of business excellence, efficiency, and effectiveness. Total Quality Management (TQM) is a managerial approach to achieve an outstanding business excellence. There are several approaches to apply TQM principles at any organization. Industry 4.0 could be utilized as a key enabler for TQM especially by integrating its techniques with the TQM best practices. This paper suggests a theoretical framework for integrating Industry 4.0 features with the TQM principles (according to ISO 9000:2015 standards family) in order to open the door for further research to address the real impact of utilizing Industry 4.0 for serving the TQM implementation approaches.
Journal Article