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Quality in healthcare is the grade of excellence to which healthcare services for individuals and population is consistent in relation to present professional knowledge and increase in likely required health outcomes (Varkey et al., 2007). It is essential that quality care is related to the desired or required outcomes and is evidence based. Domains of quality in healthcare include equity, efficiency, effectiveness, timeliness, safety, and patient centeredness (Varkey et al., 2007).

Total quality management (TQM) and continuous quality improvement is the provision of quality healthcare that fulfills or go beyond expectations through an organizational process that is structured to entail planning and executing continuous improvements by personnel. There are several key elements in TQM including training, leadership, teamwork, customer focus, and substantial investment (Varkey et al., 2007).

  1. Teamwork is a critical element especially in identifying areas for quality improvement, provision of multiple communication channels between healthcare providers and patients, improve problem-solving skills, and facilitate awareness for quality improvement.

  2. Leadership together with strategic planning form another essential element of TQM. Leadership entails vision sharing with employees for example from nurse managers to staff nurses to achieve quality improvement in relation to service provision and goods. Apart from vision sharing, leadership also entails making of strategic directions, which guide the employees in achieving quality improvement. Overall, leadership and planning are all about setting goals, sharing the goals with employees, and putting in place processes needed to achieve the set goals in the provision of quality.

  3. Training and development are essential in improving the knowledge and skills of to ensure high productivity. The formation of TQM requires that health care providers be trained to ensure their effectiveness in the provision of quality healthcare services.

  4. Customer focus is critical whether internal or external with involvement from the healthcare providers including the nurse, doctors, and other support staff. The customers in this case the patients are the foundation to the provision of health thus the providers of health have to ensure that they are the focus through providing quality goods and services to them.

  5. A substantial investment of resources is needed in TQM including money, time, and required efforts from the healthcare organizations.


Australian Safety and Quality Health Service Standards were developed by the (Australian Commission on Safety and Quality in Health Care, 2012) and are explained below.

  1. Governance for safety and quality in health service organizations. This standard explains the quality framework used to put in place safe systems by health care service provider organizations.

  2. Collaborating with consumers. Describes all strategies and systems to develop a system that is consumer centered through the inclusion of consumers in the processes of designing and developing quality health care.

  3. Preventing and controlling healthcare associated infections. Describes systems, processes, and strategies that are essential in preventing and managing infection of patients in the healthcare system.

  4. Medication safety. Describes strategies and processes to ensure that patients are informed and provided with proper prescriptions, administrations, and dispensation of medicine from clinicians.

  5. Patient identification and procedure matching. Provide descriptions of processes and strategies of patient identification and proper matching with the required treatment.

  6. Clinical handover. Provide a description of effective clinical communication systems and strategies in relation to transfer of patient care responsibility and accountability.

  7. Blood and blood products. Describes strategies and systems for safe blood and blood products storage and transfer to provide safety for the patients.

  8. Preventing and managing pressure injuries. Describes systems and strategies to prevent the occurrence of pressure injuries and management of these injuries in case of occurrence.

  9. Recognizing and responding to clinical deterioration in acute health care. Provides a description of processes and strategies to be employed by healthcare organizations to patients whose conditions deteriorate over time.

  10. Preventing falls and harm from falls. Describes systems and strategies to minimize patient falls in healthcare organization and the effective management practices in case of the occurrence of patient falls in the same organizations.

The main reasons for the development of these standards are the improvement of the overall quality of healthcare provision and protecting the public and patients from harm. Moreover, these standards are essential for the process of accreditation, which is critical in quality and safety improvement.


Availability of resources and required facilities is a critical organizational factor that influences the quality management systems. High-quality outputs, which in this case is quality healthcare through quality management systems, require high-quality inputs. Inputs include resources such as money and time and facilities including infrastructure. Healthcare service organizations need adequate resources as resource shortage can lead to stress and burnout among healthcare providers thus provision of poor quality care (Balding, 2005). On the other hand, adequate resources lead to the provision of high-quality healthcare service. Many healthcare stakeholders have identified the financial resource as the main resource in the implementation of quality management systems in organizations.

Management and leadership are also critical in the implementation of quality management systems in healthcare organizations. Poor management and leadership is an inhibiting factor in the provision of quality of healthcare since it leads to poor decision-making, problem-solving, and goal setting. Moreover, when an organization has managers and leaders that are not competent or effective, quality management systems cannot be implemented to achieve the required result, which is the quality provision of health care services. Noteworthy is that managers and leaders in healthcare organizations need to be given the required power to implement the quality management systems to ensure patients receive quality care (Balding, 2005).

Job satisfaction and motivation among the healthcare professionals working in an organization is also critical in ensuring quality management systems are implemented effectively. For the quality management systems to be implemented effectively then the employees who are the healthcare providers need to satisfied with their jobs (Balding, 2005). Important aspects that influence provider job satisfaction include pay, job security, recognition, organizational policies, leadership and management, and promotion chances. Overall, healthcare providers that are satisfied with their jobs will provide quality care through quality management systems and those that are dissatisfied will deliver poor quality care.


Communication is integral in the provision of quality healthcare as it can make or break the relationship between healthcare professionals and the patients who are the customers. The three main aspects of communication in the healthcare setting include transactions, relationships, and contexts. The perceptions of the patients concerning the quality of health care are dependent on the interaction between them and the health care provision (Asnani, 2009). Therefore, communication in the healthcare setting can either impair or enhance the overall well-being of the patient.

The diagnostic inquiry is where communication between a healthcare professional and a patient starts. Patients are different and illness varies from one patient to another and thus effective communication is needed for proper diagnosis, which will eventually lead to effective treatment and quality care (Asnani, 2009). With that in mind, then poor communication is a source of improper diagnosis and thus improper treatment and poor quality of healthcare provision. Critically, the safety and well-being of the patient are determined by treatment and the instructions to treatment need to be communicated effectively between healthcare professionals themselves, for example, a doctor and nurse and the also between the healthcare professional and the patient. Poor communication may lead to failure to follow treatment instructions properly and this is unsafe to the patient and is a source of poor quality healthcare provision (Huntington & Kuhn, 2003). On the other hand, effective communication in the provision of treatment instructions improves the overall well-being of the patient as a source of quality care while also improving patient satisfaction. In summary, communication is one of the critical aspects of the effective and proper provision of quality care. Every incidence a healthcare profession has an interaction with a patient or with another healthcare profession concerning a patient is critical in determining the quality of care. It is evident that good communication skills are a requirement for healthcare professionals as a tool for quality care and better health for the patient.


Norton and Kaplan developed the balanced scorecard in 1992 as an important way of handling strategic management (Kaplan & Norton, 1996). It was developed essentially for the private sector it can and has been applied in the healthcare sector and other organizations in different sectors. The system is applicable to healthcare provision in three important dimensions including the provision of quality care to patients, sustainability and accountability, and research and education.

First, it is essential to set a vision and mission for the provision of quality care. The vision should be to improve patient experience and outcomes through being a leader in the provision, development, and promotion of quality care. Secondly, it is critical to establish strategic goals that are essential in reaching the mission and vision. Goals are set in line with the vision, which can promote quality and safe healthcare provision, use technology and other factors to develop systems that are important in providing safe and quality care, and be at the forefront in providing safe and quality care. Thirdly, it is important to set measures for each of the goals developed. The measures are essential in tracking and following the progress to ensure the goals are met. Finally, it is critical that the targets are set for the developed measures.

The model involves four perspectives including the customer perspective, financial perspective, learning perspective, and business perspective (Kaplan & Norton, 1996). All these perspectives can be applicable to the healthcare sector. The customer perspective is considered through respecting patient needs through providing them with high-quality care. The financial perspective is achieved through the consistent delivery of good financial performances to satisfy all the shareholders involved. Learning perspective is to be a leader that is recognized in training and development of healthcare providers’ skills and knowledge. The business perspective entails being recognized as leading or premier healthcare provider organization in the market or even globally.


Asnani, M. R. (2009). ‘Patient-physician communication.’ West Indian Med Journal, 58(4):357- 61.

Australian Commission on Safety and Quality in Health Care. (2012). National Safety and Quality Health Service Standards (September 2012). Sydney. ACSQHC.

Balding, C. (2005). ‘Strengthening clinical governance through cultivating the line

Management role.’ Australian Health Review, 29(3):353-359.

Castle, N. G. & Sonon, K. E. (2006). ‘A culture of Patient Safety in nursing homes.’ Quality and safety in Health Care. 15(6): 405-408.

Huntington, B., & Kuhn, N. (2003). ‘Communication gaffes: A root cause of malpractice claims.’ Baylor University Medical Center Proceedings, 16, 157-161

Kaplan, R. S. & Norton, D. P., (1996). The Balanced Scorecard: Translating Strategy into Action. Boston (MA): Harvard Business School Press.

Sarkar, D. (1998). The Managers Handbook for Total Quality Management. 2nd ed. Beacon Books; Calcutta.

Varkey, P., Peller, K. & Resar, R. K. (2007). ‘Basics of quality improvement in health care.’ Mayo Clin Proc. 82(6):735–739.