Table 1

LM&SS systems approach

LM&SS practices that are part of the systems approachDescription (Cua et al., 2001; McKone et al., 2001; Zu et al., 2008)Special aspects in a healthcare setting
Top management supportTop management accepts responsibility for quality, creates and communicates a vision focused on quality and encourages and participates in quality improvement effortsManagers and physicians together form top management
Customer relationshipCustomer needs and expectations are regularly surveyed. Customer satisfaction is measured. There is a close contact with key customersCustomers are not only patients, but also family members, caregivers, decision-makers and insurers
Quality informationTimely collected quality data are available to managers and employees, and must be used for improvementDelivering care is a complex process. Collecting accurate and reliable information is a challenge
Focus on metricsQuantitative metrics are used to measure process performance and quality performance, and set improvement goals. Business-level performance measures and customer expectations are integrated with process-level performance measures
Process managementStatistical process control and preventive maintenance are applied. Managers and employees make efforts to maintain clean shop floors and meet schedules. There is an emphasis on mistake-proof process designSafety and hygiene are crucial in a patient environment. A clean working environment and well maintained devices are a requirement
Structured improvement procedureThere is an emphasis on following a standardized procedure in planning and conducting improvement initiatives. Teams apply the appropriate quality management tools and techniquesProfessionals are trained to act with autonomy. Too much emphasis on standardization could evoke resistance
Supplier relationshipA small number of suppliers are selected on the basis of quality and involved in product development and quality improvement. The organization provides suppliers with training and technical assistanceThere are many areas of knowledge and practice. In general, each specialty has preference for certain suppliers and assortments

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