Currently, UK healthcare is encountering an unprecedented quality crisis, especially considering the overwhelming challenge of improving patient care in the face of growing demands and limited resources. Although past efforts to adopt Total Quality Management (TQM) initiatives have failed to produce desired results, this thesis investigates the limitations of TQM applicability and explores the development of an innovative Quality Improvement model germane to a healthcare context. By integrating TQM with concepts from Corporate Social Responsibility (CSR), Complexity Theory (CT) and Knowledge Management (KM) a novel TQM conceptual framework, called EALIM—Ethical, Adaptive, Learning and Improvement Model—was devised. Using an Action Research (AR) study, EALIM was implemented within a private healthcare firm by working collaboratively with organisational members over a period of eighteen months. The study included gathering qualitative data in three AR cycles: 1) pre-implementation, 2) implementation and 3) post-implementation. The first cycle involved gathering data to form a baseline assessment of the organisation, which was used to provide feedback to top management on areas for improvement. In the second cycle, an action plan was developed with top managers and EALIM’s implementation was examined. In the third cycle, further data were gathered and findings were evaluated against the baseline assessment from the first cycle to identify the overall impact of EALIM on the organisation. Findings indicated that EALIM’s adoption generated a moral perception of the organisation, a learning culture, increased organisational commitment and an improvement in patient self-advocacy and independence. Factors that contributed to these outcomes were top management commitment, employee empowerment, the use of trans-disciplinary groups and practice-based training. However, other findings indicated that poor leadership and staff nurses’ use of managerial control created variability in service quality. These findings suggest that while EALIM can lead to organisational improvement, the commitment of all internal stakeholders is required to achieve sustainable quality patient care.

Recent marketplace realities and trends have forced health care institutions to adopt strategic orientations that stress a customer focus. Central to such strategic orientations is the effective utilization of service quality practices and philosophies. Toward that end, this research offers health care institutions an affordable methodology. A real-life application of the rapid assessment methodology (RAM) in a health care operational setting is presented. Finally, a framework to guide the implementation of the RAM methodology is outlined and explored.

<p>Telecommunication systems are under constant development. Currently 3GPP is working on an evolution of the 3G-standard, under the name 3G Long Term Evolution (LTE). Some of the goals are higher throughput and higher peak bit rates. A crucial part to achieve the higher performance is channel dependent scheduling (CDS). CDS is to assign users when they have favorable channel conditions. Channel dependent scheduling demands accurate and timely channel quality reports. These channel quality indication (CQI) reports can possibly take up a large part of the allocated uplink. This thesis report focuses on the potential gains from channel dependent scheduling in contrast to the loss in uplink to reporting overhead.</p><p>System simulations show that the gain from channel dependent scheduling is substantial but highly cell layout dependent. The gain with frequency and time CDS, compered to CDS in time domain only, is also large, around 20\%. With a full uplink it can still be a considerable gain in downlink performance if a large overhead is used for channel quality reports. This gives a loss in uplink performance, and if the uplink gets to limited it will severely affect both uplink and downlink performance negatively.</p><p>How to schedule and transmit CQI-reports is also under consideration. A suggested technique is to transmit the CQI reports together with uplink data. With a web traffic model simulations show that a high uplink load is required to get the reports often enough. The overhead also gets unnecessary large, if the report-size only depends on the allocated capacity.</p>

Telecommunication systems are under constant development. Currently 3GPP is working on an evolution of the 3G-standard, under the name 3G Long Term Evolution (LTE). Some of the goals are higher throughput and higher peak bit rates. A crucial part to achieve the higher performance is channel dependent scheduling (CDS). CDS is to assign users when they have favorable channel conditions. Channel dependent scheduling demands accurate and timely channel quality reports. These channel quality indication (CQI) reports can possibly take up a large part of the allocated uplink. This thesis report focuses on the potential gains from channel dependent scheduling in contrast to the loss in uplink to reporting overhead. System simulations show that the gain from channel dependent scheduling is substantial but highly cell layout dependent. The gain with frequency and time CDS, compered to CDS in time domain only, is also large, around 20\%. With a full uplink it can still be a considerable gain in downlink performance if a large overhead is used for channel quality reports. This gives a loss in uplink performance, and if the uplink gets to limited it will severely affect both uplink and downlink performance negatively. How to schedule and transmit CQI-reports is also under consideration. A suggested technique is to transmit the CQI reports together with uplink data. With a web traffic model simulations show that a high uplink load is required to get the reports often enough. The overhead also gets unnecessary large, if the report-size only depends on the allocated capacity.

The first goal of this investigation was to undertake a non-equivalent quasi-experimental design to test the effect of a total Quality management (TQM) approach to improve the appropriateness of clinical laboratory test utilisation in the management of early acute myocardial infarction (AMI). The study was conducted at 2 public hospitals in Sydney over a 30 month period, and in 2 stages- pre and post TQM intervention. Using specifically a Continuous Quality Improvement (CQI) FOCUS-PDCA model, a multidisciplinary team was empowered to make appropriate changes in order to improve a variety of problem areas that affected the total pathology service. Improvement was directed at the total system of pathology testing, not just test ordering. It was observed that the introduction of a TQM environment had provided a more committed, integrated and motivated clinical care effort towards improving the appropriateness of test ordering. Such team efforts were accompanied by demonstrated customer satisfaction at various aspects of the laboratory service and further benefits to patient care. Patient care benefited greatly from the highly significant changes towards more appropriate timing of blood collections for cardiac enzyme testing. Other improvements included overall improvements to the turnaround time of test results, reductions in specimen delivery delays, more appropriate use of clinical laboratory tests, a streamlined distribution of printed reports and marked improvements in communication between staff involved in the process of test ordering. Of major importance was the finding that CQI strategies resulted in substantial savings of 23.0% of the overall cost of pathology services. Adoption of the TQM approach appears to be a strategy worthy of exploration by laboratory directors and health administrators interested in improving patient care while at the same time reducing expenditure. / Doctor of Philosophy (PhD)

Objective: To assess the feasibility of applying Quality Management philosophies and techniques to pathology laboratories. Design: Series of case studies. Setting: Two tertiary referral pathology laboratories in Australian University teaching hospitals. Intervention: Application of Continuous Quality Improvement techniques to complex laboratory processes; Implementation of formal Quality Systems into laboratories; Introduction of a new Laboratory Information System. Measurement: Measurement of changes in key performance indicators. Results: Statistically significant improvements in a variety of key performance indicators, reduction in frequency of incidents, and improvement in surrogate clinical outcomes were achieved using Quality Management approaches in pathology laboratories. Comparison of environments associated with introduction of a new Laboratory Information System identified the presence of a formal Quality System as a key factor associated with superior laboratory performance. Conclusion: Quality Management can be applied successfully to a variety of pathology laboratory environments, and can result in significant improvements in product and service quality. A key success factor in implementing Quality Management may be the introduction of a formal Quality System.

The first goal of this investigation was to undertake a non-equivalent quasi-experimental design to test the effect of a total Quality management (TQM) approach to improve the appropriateness of clinical laboratory test utilisation in the management of early acute myocardial infarction (AMI). The study was conducted at 2 public hospitals in Sydney over a 30 month period, and in 2 stages- pre and post TQM intervention. Using specifically a Continuous Quality Improvement (CQI) FOCUS-PDCA model, a multidisciplinary team was empowered to make appropriate changes in order to improve a variety of problem areas that affected the total pathology service. Improvement was directed at the total system of pathology testing, not just test ordering. It was observed that the introduction of a TQM environment had provided a more committed, integrated and motivated clinical care effort towards improving the appropriateness of test ordering. Such team efforts were accompanied by demonstrated customer satisfaction at various aspects of the laboratory service and further benefits to patient care. Patient care benefited greatly from the highly significant changes towards more appropriate timing of blood collections for cardiac enzyme testing. Other improvements included overall improvements to the turnaround time of test results, reductions in specimen delivery delays, more appropriate use of clinical laboratory tests, a streamlined distribution of printed reports and marked improvements in communication between staff involved in the process of test ordering. Of major importance was the finding that CQI strategies resulted in substantial savings of 23.0% of the overall cost of pathology services. Adoption of the TQM approach appears to be a strategy worthy of exploration by laboratory directors and health administrators interested in improving patient care while at the same time reducing expenditure. / Doctor of Philosophy (PhD)

<p>As the philosophy of doing business shift from sell what you can produce to produce what you can sell so do the customers’ specification continuously become a vital tool during product development process, hence increasing the volatility of the business environment. The objective of this thesis is to thoroughly review literature to be supported by cases why most companies fail in sustaining improvement programs then map out a pathway that will leads to successful implementation.</p><p>A series of reasons were found which impedes the successful implementation of improvement programs which includes; management is unable to define the problem to be solve and the method of measurement, implementers choose wrong parameters for improvement, implementers sub-optimize or may not involve everyone that will be affected by the program, top management gives little or no attention to improvement programs and at times they may even loose focus, so many concurrent improvement programs are executed which will result to resource overloading, teams members most often lack data integrity, and teams members are often scared to try new ideas hence prohibiting the chances of innovation. To minimize this cankerworm, a number of steps has been mentioned. The steps were divided into two phases, the selection phase and the implementation. The selection process includes; defining the program, focus program on improving shareholders’ value and choose program base on a holistic perspective. The implementation phase includes; commitment of top management, prioritize projects, use critical chain project management to plan and execute project, lay emphasis on quality data, minimize the number of concurrent projects, encourage risk taking, and spend time and resources on value adding activities.</p>

As the philosophy of doing business shift from sell what you can produce to produce what you can sell so do the customers’ specification continuously become a vital tool during product development process, hence increasing the volatility of the business environment. The objective of this thesis is to thoroughly review literature to be supported by cases why most companies fail in sustaining improvement programs then map out a pathway that will leads to successful implementation. A series of reasons were found which impedes the successful implementation of improvement programs which includes; management is unable to define the problem to be solve and the method of measurement, implementers choose wrong parameters for improvement, implementers sub-optimize or may not involve everyone that will be affected by the program, top management gives little or no attention to improvement programs and at times they may even loose focus, so many concurrent improvement programs are executed which will result to resource overloading, teams members most often lack data integrity, and teams members are often scared to try new ideas hence prohibiting the chances of innovation. To minimize this cankerworm, a number of steps has been mentioned. The steps were divided into two phases, the selection phase and the implementation. The selection process includes; defining the program, focus program on improving shareholders’ value and choose program base on a holistic perspective. The implementation phase includes; commitment of top management, prioritize projects, use critical chain project management to plan and execute project, lay emphasis on quality data, minimize the number of concurrent projects, encourage risk taking, and spend time and resources on value adding activities.

Objective: To assess the feasibility of applying Quality Management philosophies and techniques to pathology laboratories. Design: Series of case studies. Setting: Two tertiary referral pathology laboratories in Australian University teaching hospitals. Intervention: Application of Continuous Quality Improvement techniques to complex laboratory processes; Implementation of formal Quality Systems into laboratories; Introduction of a new Laboratory Information System. Measurement: Measurement of changes in key performance indicators. Results: Statistically significant improvements in a variety of key performance indicators, reduction in frequency of incidents, and improvement in surrogate clinical outcomes were achieved using Quality Management approaches in pathology laboratories. Comparison of environments associated with introduction of a new Laboratory Information System identified the presence of a formal Quality System as a key factor associated with superior laboratory performance. Conclusion: Quality Management can be applied successfully to a variety of pathology laboratory environments, and can result in significant improvements in product and service quality. A key success factor in implementing Quality Management may be the introduction of a formal Quality System.