الفهرس 
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Abstract
The objective of this thesis is to design a model for quality management system applicable to healthcare service industry in Egypt, taking into account all the challenges that it faces.
The proposed model is a TQM model. It is a totally integrated model designed to change hospital culture by Continuous Quality Improvement (CQI) in order to meet patients’ satisfaction and staff requirements. This is to enable hospitals to become better at service quality while becoming more productive and competitive as well. The proposed model has the following advantages:
1. The model is simple and easy to explain to different healthcare groups such as physicians, nurses, administrators, and ancillary personnel.
2. It can easily build quality awareness among all employee in the healthcare industry.
3. The model is truly linked to the basic principles of TQM philosophy and is written specifically to be used in the healthcare service industry. It can also be used – with some modifications – to other service and manufacturing industries.
4. The model can be used for the whole healthcare organization, or by individual services.
5. Any standard or requirement can be mapped to the model.
6. When the format or contents of a published standard change, the model would not need to be rewritten or renumbered.
7. The model improves communication by showing both management and technical staff the interrelationships of their respective work processes.
A common misconception of the implementation of TQM is that it will replace traditional quality assurance (QA). The truth is, TQM and QA need to be merged to provide the most benefit to the organization.
The proposed model consists of the following seven main pillars. These are:
1. Dissemination of a Comprehensive Definition of Healthcare Quality
The concept of quality is difficult to define in the service industry. In the health industry, the concept is even more difficult to define given the fact that there are many participants involved in the delivery of healthcare, each having his own interest. Quality of care should not include only technical care but should also include interpersonal relationship and amenities of care as well.
2. Customer Focus
The principle of customer focus may be better applied in healthcare when the manager is aware of the dual nature of medical quality and is able to define customers and stakeholders as well as their respective expectations and requirements.
To be a customer – focused organization, the following four points are emphasized:
i. Identifying customers.
Ii. Customer requirements.
Iii. Patient satisfaction.
Iv. Patient rights and organization ethics.
3. Enhancing Management and Leadership Roles
Healthcare managers still face major challenges such as:
i. Changing Demand.
Ii. The Hospital Growth Imperative.
Iii. An Increasingly Consumer-Driven Market.
Iv. Competition.
V. Quality Imperative.
Vi. Digital Hospitals.
Vii. Leadership Shortage.
To enhance the management role in the quality function, the following main points are emphasized:
- Current challenges of healthcare managers.
- General Principles for managers to redesign the health system
- Deming’s 14 Quality management principles.
4. Creating An Appropriate Culture
Creating an appropriate culture is the fourth pillar in the proposed model. Some organizations have found it difficult to implement TQM models successfully. An examination of the literature suggests that only one-third to one-half of organizations have observed significant improvements through TQM programmes. This lack of significant success is often not a failure of the TQM concept, but a failure to pay sufficient attention to the cultural and structural variables that influence TQM. Unlike other programmes (such as the automation of production systems), TQM involves changing the way people interact and work in organizations. As such, TQM is a context-dependent programme, the success of which depends to a large extent on cultural and structural factors.
To investigate the organization culture for TQM context the following seven main pointed are analyzed:
i. What are the basic relationship between culture and TQM?
Ii. What are the factors affecting organizational culture?
Iii. What are the basic features for both of “positive” and “negative” cultures?
Iv. How can we introduce change in the organizational culture?
V. Does the national culture affect TQM implementation? How?
Vi. How can we promote a positive culture throughout the organization?
Vii. How can we deal with cultural resistance?
5. Focus on Human Component
Focus on human component represents the fifth pillars in the proposed model. This addresses key human resource practices—those directed toward creating and maintaining a high-performance workplace and toward developing staff to enable them and the organization to adapt to change. Human resources may be the most effective sustainable competitive advantage. This focus includes:
i. An organization – wide strategy for total involvement and Empowerment.
Ii. Fostering Teamwork.
Iii. Institute proper education and training.
Iv. Establishing an information – management system to obtain, manage, and use of information.
V. Ensure appropriate communication activities.
6. Promoting Measuring Practices
Measurement is central to the concept of hospital quality improvement. It provides a mean to define what hospitals actually do, and to compare that with the original targets in order to identify opportunities for improvement. Hence, this is included in the proposed model as the sixth pillar.
Promoting measuring practices in healthcare are described through the following main topics:
• Performance Measurement.
• Quality of medical care measures.
• Patient’s assessments of their care.
7. Emphasizing the Role of Quality Improvement
This is the last pillar in the proposed model. It is the central pillar around which all other pillars are revolving. In spite of this, quality improvement efforts, may encounter barriers that limit the impact of these quality efforts. These issues have included the cost of quality programs, the narrow impact of these programs, the inability to disseminate improvements throughout the organization, the difficulty of sustaining improvements and the lack of true financial incentives in the marketplace for improved quality.
To emphasize the role of quality improvement, the following points are analyzed:
i. Some basic Principles for improvement.
Ii. Building an improvement plan.
Iii. Implementation models.
Iv. Improvement tools.
V. Quality improvement programs.