A proposed model of Quality Management in the Iranian health care context

Health care is undergoing fundamental changes. The current health care environment changes on a daily basis. The influence of rising costs of health care and consumerism has resulted in significant changes in health care delivery. Changes in health care are apparent as health care organizations continue to redesign or restructure systems to survive in a highly competitive marketplace (Lambert et al. 1999). The rapid pace of change in the health care system presents tremendous challenges for health care managers charged with the delivery of health care services. Declining reimbursement, new incentive structures, and increasing competition are placing unprecedented pressure on providers to deliver health care efficiently. Consumer dissatisfaction, and a growing awareness of gaps between actual and ideal practice have led to intensifying pressure to improve quality (Hermann et al. 2000). It is dynamic and difficult to manage competition and consumer expectations. The future is full of challenges for health care managers. Consumers and payers demand high quality health care services at reasonable and affordable costs. Health care managers must find new ways to provide services to meet these requirements (Besterfield 1999). Today’s competitive world demands effective and flexible strategies for meeting the ever-changing challenges to the healthcare industry. The key to success for those managing healthcare facilities is the ability to perceive future trends and integrate them into quality management strategies. The aim of those strategies is to create quality management as a controlling and navigation tool in a "New-Economy-based" healthcare system (Ekkernkamp et al. 2000). Quality management constitutes an appropriate response to this challenge. It is a way to organize work flows in health care organizations as usefully as possible and to achieve an optimum outcome quality, i.e. quality of health care services, patient satisfaction, employee satisfaction and overall performance results. One of the most important objectives of health care organizations is to achieve the greatest possible improvement in health care services at the lowest possible cost to both the patients and the health care providers. Quality systems in the domain of health care have one primary aim. This aim is to improve quality and to build up the confidence of patients, professionals and cost payers in the quality of the structures, the process, and the outcomes. Systematic and continuous improvement of quality of health care services has been on the agenda of many health care organizations in the last decade. The modern quality field in health care systems is about one-third of a century old. In the last 30 years many health care organizations implement quality improvement activities. Quality, quality assurance, and quality management have been important topics in health care organizations in these years. Quality within health care services organizations continues to be a contentious issue. The role of quality programs and criteria for performance excellence in health care organizations is evolving.