“Ovidius” University Annals, Economic Sciences Series

Volume XV, Issue 2 /2015

Quality Management in Healthcare Systems

Adriana Grigorescu
National University of Political Studies and Public Administration
adrianagrigorescu11@gmail.com
Elena Condrea
Ovidius University from Constanta
elenacondrea2003@yahoo.com
Christopher De Freitas Bradley
Valahia University of Tărgoviște

Abstract insurance companies, and additional

Quality management within health care
systems offers a structure which can provide
assistance for clinics/hospitals in order to
consolidate relations, interconnect, observe,
and subsequently improve all facets of
healthcare management.
Quality management offers proof in order
to support the plan that a structured
organization is essential in attaining health
care services of high quality, which can
ultimately result in lesser health care
expenses.
Recent studies have evidently defined two
main areas in the efficient management of
quality:
1) Low levels of Productivity;
2) Unused Quality; where healthcare quality
of high standards can result in significantly
lower charges.
Quality can openly address the most
important requirements of each group,
achieve a balance of partnership amongst
healthcare providers, physicians, and
patients, and ultimately permit the healthcare
delivery system to efficiently acknowledge the
standard of quality in a very demanding
setting.
Keywords: Quality management, healthcare
management.
J.E.L. Classification: I18, M19
1. Introduction
Economically centered efforts to limit
healthcare costs and price competition (for
example discounts offered by hospitals to
strategies for healthcare services) have
conveyed a collective level of pricing to most
healthcare service providers. Due to this fact,
the next level of focus will inevitably move
towards quality, and any upcoming rivalries
will be primarily founded on noticeable
superiority in the quality of services offered.
The clinical outcome and delivery of quality
will be significant.
The search for a higher standard of quality
delivers a balanced structure for cost control.
The healthcare business has been exposed to
external pressures when in reference to cost,
the key mechanisms of the healthcare system;
physicians, hospitals, and insurance
companies have followed contradictory
objectives with a high rate of incidence. This
matter has ultimately resulted in an
augmented friction within the healthcare
industry, and subsequently a sub-par ability
to resolve more serious complications (Rose,
2005).
As a result of the external pressures which
we as a community face, the healthcare
system is concentrating an excessive amount
of its energy on in-house discrepancies.
2. Improving healthcare delivery using
quality management
1. An efficient portrayal of quality.
Although there are numerous methods
available to comprehend quality, there are
methods set in place based on a philosophy
of quality management which is known as
the constant improvement of quality. There
are specific reports from implementing such
methods which can be beneficial for the
reason that, they noticeably define the

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association between cost and quality, as well
as resulting in a structure for an organized
control of quality or cost. They demonstrate,
in what manner the search for a higher
standard of quality in healthcare can result in
significantly lower costs in the delivery of
healthcare services.
By applying this philosophy, we may view
quality along these lines: The health care
system is a sequence of intertwined
processes, which separately result in multiple
outputs. Each individual’s perception of
quality is represented by their subjective
assessment of an output as well as the
individual exchanges that occur at the
moment of output delivery. The expectations
of individuals are based on previous
experiences and desires. Therefore, there can
arise quality evaluations as part of a value
system which can be monitored and altered
over time from learning.
The two main components of quality are
delivery and content. The quality of delivery
reveals the interaction between the
patient/customer and the health care system.
In doing so there are a few aspects these
individuals tend to notice when visiting a
hospital/clinic; firstly, cleanliness is a very
important characteristic, then there would be
the level of responsiveness and information
offered by the staff, finally the prompt
delivery of services executed with
professionalism.
The quality of content is based on achieved
results. It used to be the role of physicians or
health care professionals to judge the quality
of content, nowadays patients and customers
are playing a more active part in the
assessment of health care delivery.
2. Quality-Cost association.
There are five distinct ways in which
quality can relate to cost:
a) Low levels of productivity
Takes place as soon as two processes
create an identical chosen output, however in
order to achieve this action, one process
consumes more resources than the other.
b) Unused Quality
Unused quality signifies the necessary
funds in order to repair the output of a
process in the event of output discard or
quality failure. Furthermore, quality failure
includes costs associated with poorly
managed businesses as well as time spent
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Volume XV, Issue 2 /2015
dealing with disappointed clients rather than
dealing with managerial obligations.
c) Cost versus Benefit
Deals with the notion of maximizing
versus optimizing, for example, if the
addition of a new care unit results in hardly
any benefits but has a significant cost, the
age old question comes to mind – Is it worth
it? Physicians want to think that they
maximize the benefit while disregarding the
cost, more often than not; they usually take
into account the perceived benefits in regard
to cost.
d) Environmental health and the
prevention of diseases.
Studies have shown that preventive
medicine is the most cost effective method
amongst hospitals.
Productivity and quality waste suggest
possible methods of cost saving while still
maintaining a high standard of quality. Some
scholars have confidence that an increase of
20-40% of the overall healthcare outlays can
be achieved.
e) The use of new technology
Increases costs, nevertheless, it also
improves the desired medical results. Just
like in most industries a higher quality
product demands a higher, yet warranted
cost.
3. The cost control system in relation to
quality.
The CQI principles are used with the
purpose of achieving the highest standard of
quality possible at the lowest potential cost.
The goal of this system is to alter the
procedure while making sure that failures in
quality don’t occur, as opposed to repairing
them after they have already happened.
The two essential principles of the system
are;
a) Achieving a high standard of quality in
relation to cost, and
b) The elimination of unsuitable variants
while monitoring improvement.
For a system of this nature to properly
function, it requires the quality objectives of
the final as well as the intermediate outputs
of both processes be defined clearly defined
in a quantifiable formula so as that all the
outputs can be assessed against the specified
terms.
4. Patient/Customer values and medical
ethics

The constant progression of quality
management in healthcare systems is done so
with the use of excellent programs, serving as
building blocks in the assurance of quality.
The CQI concept allows for the extension
of the general notions such as terms and
conditions, which have been previously
regarded as the norm. Implementing such a
philosophy allows for these methods of
quality assurance to overcome complications
with viable solutions, ultimately resulting in
a mutual satisfaction for both patient /
customer and provider as well as an overall
improvement of the standard of quality
offered.
5. Standards of quality for health care
services.
The main customers of health care services
are indeed patients. As a result, it is crucial to
measure their standards, in regards to
healthcare services and make every effort in
order to achieve those expectations every
single time. If certain expectations are
unreasonable or downright impossible, the
key lies in educating the general population
or consumers, so that, in the future patient
expectations become achievable.
6. Cost of Healthcare: There are three key
aspects to consider:
Firstly, the quality of healthcare services
offered is directly proportional to the
capabilities and professionalism of the
medical personnel as well as the managerial
abilities of hospital administrators.
Secondly, there is the fear of misdiagnosis
of patients leading to unnecessary treatment
and hospitalization. Studies have shown that
in some misdiagnosed cases, a significant
amount of medical procedures and especially
interventions are inappropriate. This leads to
wasting of resources, but more importantly
can also harm these patients in the process,
therefore this aspect is of particular
importance to healthcare investors.
Thirdly, is the way in which
patients/customers are treated. Here is where
resource utilization comes into play, in order
to accomplish similar results for specific
procedures and diagnoses. A perfect example
of wasting productivity is the maintaining of
incorrect variations of services even when the
same results are obtained every time.
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Volume XV, Issue 2 /2015
3. Methods for quality improvement and
resource management
There are certain measures one could
apply in order to improve quality of health
management (Cianfrani and West, 2009; Ellis
and Whittington, 1993):
Preparation is very important, it is
essential in obtaining optimum results. Once
you are prepared, the next step is
implementing the desired method. Lastly,
and perhaps the most important is being
innovative and coming up with the next
revolutionary procedure in healthcare
management. In order for this system to
function properly there needs to be
continuous observation and documentation of
functional and non-functional
implementations, such as, cost control and
the elimination of incorrect variations of
healthcare delivery.
The key to an effective system relies the
importance of understanding the true essence
of quality, and being able to apply it in areas
that need fixing. This procedure embraces the
interaction between customer and provider,
through communication and the
understanding of customer’s needs, the
overall satisfaction and moreover efficiency
of healthcare delivery will inevitably
increase.
To improve quality in hospitals as well as
strengthen relationships between the cost of
procedures and the quality of services
offered, the following actions should be
highly considered; First, and foremost is
finding a process that works for you, if this
means using a method applied by someone
else in your field, or taking ideas from
multiple methods, that is all fine, as long as
it’s efficient. There exist a number of distinct
processes for clinical practice, whether it be
diagnostic techniques or personalized
medical procedures, they are the core of
maintaining the quality of healthcare delivery
(Campbell and ot, 2002).
Some methods cut diagnostic lines in half;
the most common of examples are hospital
admission, analyzing blood tests, and
solicitation of payment. Finding the process
which requires improvement is the only the
beginning.
After choosing your intended method,
then you must assemble a staff that is
familiar with your system. Finding personnel

who are experienced and understand the
process is essential for the increase in
productivity. Each individual should be
aware of the principles of quality
management and cost control, or at least have
some sort of notion in order for them to
function efficiently as a team.
Last, but certainly not least, is meeting
customer/patient expectations. Quality can be
defined as meeting or exceeding the
expectations of customers, this particular task
relies highly on the conditions in which
customers are being educated on the values
of expectations and their ability to change
over time. The most challenging task for the
group is dealing with the different feedback
offered from different expectations of
customers. To maintain a balance in
productivity they should first list the different
outputs of the procedure, identify the
customers, and measure their expectations of
quality
Stressing the importance of doing these
procedures strictly in writing is crucial. For
far too long, many hospital administrators
have viewed their own expectations to be the
same as their customers. This mindset can
ultimately lead to a degradation of the
system, in the sense that, it may seem as if
everything is efficient in the eyes of the
manager, when in actuality customers’
expectations are not being met consistently.
The easiest method to avoid this downward
spiral is the appropriate listing of customer
feedback and being able to quantify
expectations.
Administrative members should meet bi-
yearly or at least once a year in order discuss
productivity, functionality of procedures,
customer satisfaction, and update the list
accordingly. This includes implementing new
procedures in areas that lack results,
maintaining standards, and replacing
unsuccessful variations with new more
efficient ones. This process is necessary in
order to assure quality, because as customers
gain knowledge, the process begins to
evolve, thus altering customer expectations
(Benneyan and ot, 2003; Nederpelt, 2012).
In the field of medicine, the patient is the
entire medical profession. Clinical
procedures of diagnoses can be regarded as
the measurement of expectation, which can
be obtained by simple writing these
procedures down and formulating a
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Volume XV, Issue 2 /2015
hypothesis which should be investigated
further. Due to the fact that these
expectations are generated by the medical
profession as a whole, not by particular
physicians or healthcare institutions, a
profession wide scale would be the best way
to document these procedures.
4. Recording the process
A process is an assortment of organized
tasks originated as a reaction to a specific
event which results in a particular outcome
for the customer of that process. These
processes usually involve a hierarchy,
consisting of the three main categories of
inputs, outputs and processes being broken
down further into subcategories. Each of
these processes can be broken down even
further into sub-subcategories, and so on and
so forth. There is an unbelievable amount of
detail which goes into the construction and
understanding such an intricate procedure.
The features of this process can
sometimes be connected to the outputs but do
not necessarily result in their outcome. Some
outputs can be viewed as “laid back”, due to
the fact that, whether they are present or
absent it does not affect the result of the
process. There are strategic elements to a
process; these elements can determine the
expectations of quality set by the output. It is
important to note the elements which produce
the desired effect.
Applicable facts result from acquiring the
necessary knowledge in order to understand
the essential methods required for a process
to function correctly. This knowledge can be
obtained by performing these procedures on a
day to day basis. By performing these tasks
daily for an extended period of time, one
grows accustom to the procedure and begins
to build a routine. Over time, ideas on how to
improve this daily routine start to develop
and be put into practice. In this particular
instance, and in general, a process will not be
able to manage without basic applicable
knowledge.
Output generation and the stipulations of
processes, are unequivocal, quantifiable
statements in regards to the importance of the
output’s attributes.
In the lists which were asked to be drawn
up by the team, there can be a sub-group of
stipulations, resulting from the output of

customers and their expectations, and the
necessary steps which lead to this process.
These so called stipulations are what define
the quantifiable variables, at the same
offering no guarantees as to what levels of
achievement they will result in.
There are two main levels at which these
stipulations can be generated; on an external
level, which results from customer
expectations, and on an internal one,
generated by the expectations of the process.
These levels reflect two distinct features; the
objective of the process as well as the manner
in which it strives to achieve that intended
target. Once again, documentation is crucial
to allow for appropriate measurement of
customer expectations, in addition to
improvement of the process leading to
alterations in customer expectations over
time.
As in any process, stipulations are an
integral component of that system. For these
specifications to work they need to be
recorded and quantified, in order to properly
measure the consistent achievement of their
objective. A large amount of resources are
consumed by healthcare organizations in an
effort to produce suitable conditions as well
as develop applicable systems of quantified
data management. Well-defined stipulations
provide a foundation for the integration of a
goal orientated system of measurement,
furthermore providing the necessary
opportunities for constructive criticism on
improving the quality of healthcare delivery.
The importance of recording the process is
often stressed because it facilitates the
alteration of unproductive processes with
new ideas for more functional ones. As these
processes begin to be better understood, the
next intention is to tailor them to customer
expectations.
Constant improvement of quality is a
process based on improvement of quality
resulting from customer outputs and
expectations. To gain a better understanding
of the principles put in place by the process,
but also the stipulations which are applied in
their management, one must refrain from
being subjective and focus strictly on
gathering data from an objective perspective.
This particular concept focuses on
customers’ expectations and hitting that
desired target every single time. Although
this task is far from easy, due to the actions
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Volume XV, Issue 2 /2015
of different hospitals taking place on
different levels. For example, the quality of
medical content and their results should be
evaluated based on the expectations of the
entire medical profession, resulting in the
eradication of unsuitable variations in the
results of medical procedures. Results of
system functionality can be easily shared
with other organizations as well as physicians
in order to achieve an optimal process which
can be applied universally.
Some hospitals/clinics have their
processes taking place on a smaller scale,
focusing more on satisfying local customers,
rather than concentrating their efforts on
improving the entire healthcare system
(Freed, 2005). Hospitals can forge
partnerships with other hospitals/clinics in an
attempt to apply similar management
systems. If their systems are functional, the
collected data can be used as a marketing
tool, for instance, hospitals can use patient
surveys to advertise their rates of satisfaction
in comparison to other hospitals, which will
hopefully result in the influx of more
patients. This process can also lead to
greater efforts by hospital administrators to
implement procedures of constant
improvement of quality, under continuous
documentation in the hopes of discovering a
more functional method which they can then
share on with other healthcare personnel
There are a few simple tasks any
administrator can perform in order to
improve the standard of quality offered. The
most important of the lot are creativity and
commitment. Having a vision for the
intended path of your institution is the key in
assuring a high level of quality. Conveying
this method to your staff, but more
importantly gaining the board’s acceptance is
essential in developing the next functional
step.
Perhaps on the same level of importance
as creativity and commitment is knowledge.
Having experience in the field and
understanding business strategies leads to
better organization through the
implementation of acquired managerial
techniques. After having established an
intended pathway and put into place a desired
system for quality management, the next
important step is identifying your target
customers, having knowledge of your offered
products and documenting your processes to
 “Ovidius” University Annals, Economic Sciences Series
Volume XV, Issue 2 /2015

ensure the terms and conditions are on point. biggest opportunity for improvement of
Next, you must train your staff in order to quality are, eliminating inappropriate
successfully apply and document your treatment and hospitalization of
method. Your employees must be taught the misdiagnosed cases, through education and
basic principles of quality and customer experience.
expectations, if done correctly, their
knowledge will grow over time allowing 6. References:
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administrative team is entrusted with the
tasks of assembling and supervising these
particular processes. The success of an
organization in the constant improvement of
quality, depends on the managerial abilities
of the administrator.
There have been a number of studies
conducted on the indications for treatment of
a disease and the intended course of action
taken after the treatment is prescribed. This
particular variation can be closely related to
low levels of productivity as well as unused
quality, resulting from a lack of clinical
experience by physicians and medical
personnel, as well as inadequate data on the
clinical treatment of patients on order to base
their decisions on. It is imperative that
healthcare personnel document and record
improvement in all designated areas of
healthcare delivery, the two areas which can
be the most cost saving as well as offer the

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