Total Quality Management Threatens Medicare
Price, John, Canadian Dimension
Workers and unions in health care facilities in BC and other provinces are increasingly confronted with an array of management-sponsored employee involvement or participation programs. These include Quality of Work Life (QWL) committees, Shared Governance projects, Healthy Hospitals, Total Quality Management (TQM), and Continuous Quality Improvement (CQI). Of all these programs it is the latter TQM/CQI, that may have the most profound impact and pose the greatest challenge to health care workers.
Many health care administrators and some physicians and government officials are already buying the TQM prescription. And no wonder. According to Hassen, TQM promises to maximize "human skills, creativity and resourcefulness, customer satisfaction, employee involvement, effective and efficient use of resources, continuous improvement of all processes large or small, and the consistent achievement of high standards of service and productivity."
TQM programs usually begin with the hiring of a TQM consultant or by sending a union-management team to quality seminars. This is often followed by an employee survey, and eventually the creation of a quality council. The quality council identifies key processes that supposedly need improvement in a facility, nominates a team to work on the problem, and then assures the team's proposals are integrated into day-to-day operations.
But as workers and unions in health care facilities are exposed to the new programs, doubts are emerging about whether TQM can deliver on its promises. Is TQM the wonder drug that some claim? Or is it a new brand of snake oil with some nasty side effects for health care workers and for Medicare?
St. Paul's, Royal Columbian, Surrey Memorial, Greater Victoria Hospital Society, Langley and Penticton Regional as well as extended care facilities such as Juan de Fuca Hospitals in Victoria, are among the dozens of BC facilities that have established quality programs in the last year.
In Ontario, major facilities such as St. Joseph's Health Centre in London, and Metro Toronto hospitals including Women's College, Doctors, Mount Sinai, Sunnybrook Health Science Centre, and St. Michael's have implemented TQM/CQI programs. The Ontario Ministry of Health has even found $400,000 to help hospital bosses communicate through an Ontario CQI network.
In March, the Manitoba provincial government, in conjunction with hospital administrators and private corporations, sponsored a two-day forum on TQM. The government has retained Connie Curran, a TQM consultant from APM Management Consultants of New York and Chicago. Her assignment: carve between $45 and $65 million dollars from hospital costs for a rumoured $3.8 million fee. According to newspaper reports, if TQM/CQI works, Canadian health ministers are ready to adopt it nation-wide.
It is also widely acknowledged that some administrators and consultants want TQM/CQI to become the new benchmark for quality assurance programs in hospitals. They are lobbying hard to have the Canadian Council on Health Facilities Accreditation adopt TQM/CQI as an integral part of its accreditation standards. Such a development would oblige all facilities to implement TQM/CQI programs in order to receive certification which qualifies them for provincial funding.
What will TQM deliver?
TQM/CQI programs appeal to the legitimate desire on the part of health care providers for some real input and control over their work. But behind the quality label is a sophisticated, comprehensive system based on new production techniques being used in the private sector. These techniques blend Toyota production methods (Just-in-Time, kaizen and so forth) and modern "human relations" strategies that maximize peer pressure and may even include psychological testing. Critics call the system "management-by-stress."
To be sure, there are some positive aspects to TQM/CQI that should not be overlooked. …