Next Generation Quality in Healthcare Management

Many healthcare organizations have tried total quality management, business process re-engineering, or both over the last 5-10 years. On top of these experiences has come increased clinical integration, cost cutting pressures, managed care, and changes in accreditation focus.

We have used our 20 years of experience in process improvement, performance measurement, and system modelling to blend the various change methods into a comprehensive system we call Next Generation Quality. The core TQM principles of processes, data, team work, and continuous improvement are also at the heart of Next Generation Quality. We build from the foundation of a sound clinical pathways program (process), a strong variance management system (data), and team based continuous improvement, we can create with you a powerful vehicle for achieving organizational excellence.

We believe that healthcare change requires a change in healthcare management approach. Simply complying with accreditation criteria or regulatory requirements only ensures a minimum level of quality, not organizational excellence. Compliance allows you to turn the lights on and onlock the doors. The market, though, dictates how much business walks in the door and whether you will make enough money to survive and prosper.

These changing times require new thinking about the way we do business in healthcare. Managing populations of patients across multiple locations and disciplines at lower cost and higher quality than your competitors is paramount. And difficult.

For these reasons we have developed a new approach to healthcare management and improvement. One that focuses on the core business process: clinical care. The approach, which we call Next Generation Quality, applies total quality management thinking to clinical processes.

Next Generation Quality, as the model below shows, combines pathways, variance management systems, patient documentation, and continuous improvement into a synergistic system for designing, managing, and improving clinical and operational process across organizational lines. This model allows an organization to meet the needs of its competing stakeholders: patients and their families, physicians and other care providers, managed care organizations and other payors.

Next Generation Quality Model: Pathways, Variance Systems, Documentation, and Continuous Improvement Drawing

The organization must design this model as a whole system in order for any of the pieces to work properly.

NGQ model

This model is built on the criteria and philosophy of the Malcolm Baldrige Criteria for Performance Excellence. The Baldrige criteria stress:

  • Fact Based Improvement
  • Continuous Improvement
  • Holistic systems design that links customers to strategy to action plans to indicators to results to improvement
  • Encouraging and enabling cross functional work and cooperation
  • Customer focus

In our Next Generation Quality Model we bring these concepts to clinical processes. We do this by:

  • Designing and implementing the whole system as a seamless entity
  • Using the clinical pathways as a process of care, and as a basis for organizing care
  • Improving care team collaboration through improved documentation and concurrent variance data review and action
  • Using variance data to support continuous improvement by linking process (the pathway) with outcomes data
  • Realigning the care team toward a customer focus through the multi-disciplinary pathway and more effective communication and collaboration
  • Linking variance data into an organizational balanced scorecard process.
  • We cover the components of the model in Clinical Pathways and Variance Management Systems Short Takes. We also have available Short
  • Takes on continuous improvement tools and techniques.

A new Short Take covers Activity Based Costing, a new and more accurate cost accounting method that allows you to accurately cost out your pathways and your actual performance.




Much of our Next Generation Quality Model is built around clinical pathways and variance management systems. Our partners in clinical pathways and variance systems work are:

The Center for Case Management

The Center for Case Management and its Principals, Karen Zander and Kathleen Bower, invented clinical pathways at the New England Medical Center in the 1980’s. They are the premier consulting, publishing, and training resource for clinical pathways, case management, and clinical integration.

Joule Management Technology, Inc.

A leading issue in healthcare, and one with important implications in pathway development and usage, is cost accounting: how much does care really cost? Joule’s Activity Based Costing (ABC) approach moves beyond peanut butter cost systems (just spread the costs around) to detailed and powerful costing systems built around the pathways.

Southern Medical Association

The Southern Medical Association (SMA) provides services to physicians and physician groups across the South. We have made our Next Generation Quality workshop available through SMA to its members at significant discount. Contact Ed Waldron at (800) 423-4992 for more details.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.