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Total Quality Management at Dubai Healthcare City

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The development of Dubai healthcare City (DHCC) was comprised of two phases. The first phase entailed an area of 4.1 million square feet and is already in operation. According to Noack (2007), Dubai Healthcare City has established an international medical centre to help patients from the Middle East, East Africa and India. The second phase comprised of the free zone which focuses on three core components, university medical complex, a general medical complex, and a wellness cluster. The university complex within DHCC consists of a university hospital and teaching and medical research facilities (Noack, 2007). Clinical practices, transplantation and rehabilitation centers, pharmaceutics and hospitals are located in the medical complex. The wellness cluster accommodates sports, medicine, resorts and spas, beauty farms and cosmetic surgery facilities (Noack, 2007).

According to Al Abed & Hellyer (2004) Dubai Healthcare City has a capacity of 300-bed university hospital, medical college, a nursing school for 300 students, a life sciences research centre, 40 fully equipped, ready to go clinics and specialized laboratories. The organization is gaining a bigger market share in the region as shown in the table below.

The key to the successful development is the agreement between DHCC and Harvard Medical School to form a joint venture in medical education and training, quality assurance, knowledge management, research and strategic planning. Al Abed & Hellyer (2004) noted that the Harvard Postgraduate Medical Education Program was started in 2005, covering cardiology, oncology, orthopedics and gastroenterology. In a separate development, the Mayo Clinic entered into a strategic partnership with DHCC to open a clinic in the complex. Physicians from the Mayo Clinic provide medical care on site and the partnership includes cooperation in medical care, professional consultancy and research.

The table below shows the total regional healthcares spend in 2010 forecasted $137.29bn. The total potential healthcare market available for Dubai Healthcare City in 2010 was $2.01 bn. This implies that DHCC has positive prospects and is expected to gain more market share in the entire region.  

Dubai Health Care City (DHCC) Vision, Mission and Objectives

The vision of Dubai Healthcare City is “to become the internationally recognized location of choice for quality healthcare and an integrated centre of excellence for clinical and wellness services, medical education and research”. The mission of the organization is “to provide the best possible healthcare services”. The mission of Dubai Healthcare City is achieved through working as a team to meet the needs of the patients, partnering with other renowned institutions such as Mayo Clinic and Harvard Medical School to provide health care services and training in Dubai. The Dubai Healthcare City achieves its mission by adopting the best healthcare practices. 

Dubai Healthcare City has five major objectives. The first objective is to ensure that quality health care is reachable to the people of the United Arab Emirates and its surrounding regions. The second objective is to develop headship in medical education and come up with good structures which enhance research and development in health care. The fourth objective of Dubai Healthcare City is to develop an atmosphere that enables both enhanced health care delivery and well-being of families. The fifth objective is to set up a financially feasible and sustainable integrated health community based on an inclusive enterprise of the private and public sector.  

Total Quality Management

Dubai Healthcare City is successfully implementing total quality management concepts. Total quality management can be defined as an evolving system of practices, tools and training methods for managing healthcare facilities to provide patient satisfaction in a rapidly changing environment (Nigam, 2005). A core concept in total quality at Dubai Healthcare City is the management of quality at every stage of operations, from planning and design of healthcare provision, through inspection to continual monitoring process for improvement of opportunities. 

The most important organizational and individual outcomes embraced by DHCC are comprehensive and durable changes in the mental and physical well-being of people. Mohanty & Lakhe (2001) noted that Dubai Healthcare City is progressively implementing total quality management to reduce costs, improve efficiency and provide higher quality care. Total quality management is an important part of Dubai Healthcare City’s competitive strategy. Mohanty & Lakhe (2001) further say that the healthcare city being in a competitive market is more likely to attempt to differentiate itself from its competitors in the region on the basis of better service quality. Therefore total quality management, which puts more emphasis on improved customers’ satisfaction, offers the prospect of greater market share and profitability.

Total quality management ensures efficiency in direct medical services like diagnoses, surgery, medicines and treatment, but indirect operation like  purchasing and administration, which costs are reflected in the patients’ pay. Total quality management will enable Dubai healthcare City to ensure quality performance that is directly connected and closely related to healthcare such as food, housing, safety, security, attitude of physicians and nurses. Total quality management will ensure good time management which revolves around time taken to fix an appointment, delay time, service time, timing with regard to medical treatment and surgery. 

Total quality management ensures quality of administration and management. Mohanty & Lakhe (2001) say that this quality aspect entails such operations as staffing, purchasing, supervision, appointments, discharges, emergency rooms, record keeping, prescriptions, pharmacy and medicines and laboratory work. With the implementation of total quality management Dubai Healthcare City will ensure and attain efficiency in this crucial area of its administration and management. The implementation of total quality management concepts at Dubai Healthcare City is positively associated with a greater degree of quality improvement implementation. This means that the organization can handle changes, use teamwork philosophies, and have empowered employees who receive a higher degree of benefits from quality improvement.

Through total quality management, the quality of doctors, nurses, and staff’s service at Dubai Healthcare City has reflected effectiveness. Through this quality concept a patient at Dubai Healthcare City must be satisfied that the doctor has done all that could have been done.

The key to understand how TQM works in Dubai Healthcare City is the recognition of the central importance of the patients. Patients of Dubai Healthcare City should be able to select services that meet their expectations and reject services that do not. This approach continues to be the measure of the Dubai Healthcare City’s success currently and in the future. Kavaler (2012) says that to achieve total quality management, top management must be committed to and actively involved in the total quality management process. The success of total quality management based on the application of quality improvement processes at all levels of Dubai Healthcare City.  

The leadership of Dubai Healthcare City must learn the meaning of quality including an understanding of the significance of patients to the organization. The top management of the organization must sponsor and encourage the continuous improvement of quality including the wise use of teams that can work together effectively to improve systems and processes within the healthcare organization (Brown, 1992).  Total quality management entails that change should be based on the needs of the patients, not the values of the organization. Brown (1992) says that the concept of total quality management requires meaningful participation of all personnel and a rapid and thoughtful response from top management to suggestions made by participating personnel.

It is important to note that total quality management is more than a change in values and responsiveness of practitioners, physicians, nurses and all members of staff. Brown (1992) says that total quality management requires fundamental process flow and statistical analysis, evaluation of all ongoing activities within a healthcare organization. It also requires the articulation of significant psychosocial principles affecting individuals and groups within the organization. Brown (1992) indicated that for successful adoption of total quality management, the key players must realize that most problems encountered in health care organizations are the result of not errors by administrative or clinical professionals but the inability of the structure within which the employees work. This is an important consideration for Dubai Healthcare City as it will ensure that any failure encountered in service provision does not always result from human error.

Dubai Healthcare City places primary weight for characterization of total quality management on the system rather than the individuals. Brown (1992) says that this is important to service delivery as it runs counter to the prevailing assumption that in health services a problem is a result of physicians or nurses’ error rather than of the larger structure or system within which the individual functions.  At Dubai Healthcare City, total quality management has increased personal autonomy in undertaking task-oriented change. It does not however, respect professional autonomy as much as it respects personal autonomy (Brown, 1992). This has led to continued good service provision as total quality management demands that clinical professionals hold themselves accountable for both outcome and process performance on a continuous basis. 

Dubai Healthcare City is receiving high levels quality accreditation through total quality management. This has been achieved through the use of quality circles. The responsibility for quality control in the organization is in the context of frontline managers and employees (Brown, 1992). Quality circles are small groups of employees from the same area who work on a range of problems to increase productivity and efficiency.  Maintaining quality means monitoring and teaching employees to monitor their own performance and taking corrective action. At Dubai Healthcare City, total quality management appraisals should focus on gaining skills to contribute to the process of quality improvement. Therefore the reward system at Dubai Healthcare City is based on contribution to a team effort to improve outcomes rather than on whether the specific set objectives have been achieved (Brown, 1992).  

Change Management

The implementation of total quality management requires that administrative and medical managers mediate areas of conflict within the organizational structure. New ways of decision making are required by total quality management. It also requires the ability and flexibility to be led by the need for continuous improvement within the organizational structure. Brown (1992) says that total quality management entails significant skills for statistical analysis of procedures and the ability to work within different teams.

Through the adoption of total quality management, Dubai Healthcare City should redefine its corporate culture to a supportive culture. The organization should be in the process of changing its culture, management skills, teambuilding strategies, and structure and reward system. Managers should become masterpiece conductors leading the independent actions of a diversity of professionals and project oriented teams in the organization. As a result of the continuing implementation of total quality management, the role of management has evolved to managing the culture and allocation of resources to support change process (Brown, 1992).

Under the principles of total quality management, it is important for the management to know who the patients are in order to meet their needs. Any change must therefore be accompanied by provision of flexible schedules for employees, adjusting routines for care to meet the needs of patients, extending clinic hours (Brown, 1992). Putting the customer first requires creative and innovative changes and methods to meet the ever-changing needs of both internal and external customers.  Research shows that implementing total quality management in Dubai Healthcare City has involved various considerations.

To successfully implement total quality management, the DHCC objectives should be expressed in terms of both performance objectives and process objectives. This implies that programs within different departments at Dubai Healthcare City such as sales and marketing, customer relation, business development, and patient referrals and associations will have to set their own quality objectives period by period as they develop capacity to measure, follow and modify their own processes (Brown, 1992).

Throughout the implementation of total quality management, data is collected within DHCC to guide decision making. Implementation is continually evaluated using a patient satisfaction survey which is one method used to monitor changes in clinical care. Other common methods used include clinical care audit, peer review and utilization review (Galt & Paschal, 2010). Clinical audits at the organization can be retrospective or concurrent. Dubai Healthcare City conducts both retrospective and concurrent audits. The organization’s total quality management recommendations for change are usually based on the experiences of many patients with similar care problems or also across the spectrum of care provided. Concurrent audit is also used to examine and evaluate the care provided to achieve a desired therapeutic outcome with the ability to make changes immediately based on the patients evolving health status. 

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