An ‘ecological’ approach to total quality management — a case study from NHS outpatient clinics

Abstract

A prominent part of recent British government policy has been the construction and promulgation of a series of ‘Charters’ (of which the best known is ‘The Citizen’s Charter’) in order to secure better ‘value for money’ in the provision of public services. Such Charters prescribe standards of service and may even entitle consumers to compensation if services do not reach an agreed standard. The Charter which particularly applies to the NHS (‘The Patient’s Charter’) stipulates the maximum time that patients should spend waiting in outpatient clinics by indicating that ‘you will be given an appointment time and be seen within 30 minutes of that time’. This paper uses a case study of the implementation of a statistical monitoring system in a District General Hospital which had the practical effect of greatly improving typical waiting times. Whether such improvements have increased the overall ‘quality’ of outpatient clinic organisation is a moot point and an argument will be developed which extends the normal statistical approaches to quality measurement.