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Quality in Medicine

 
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Tasks of Total Quality Management (TQM)                                                                                    

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However, if total quality is strictly applied and there are no surgical or long time risks, Refractive Surgery will have a great impact and become one of the most common interventions.

If Refractive Surgery becomes a common intervention there will be another reason for TQM. It must be guaranteed that vision even in difficult circumstances is not damaged as a result of not wearing glasses. For instance, if the number of car accidents were to rise due to problems with driving at night, the intervention could not be allowed.

Applying quality control in Refractive Surgery will also meet the recommendation of the Joint Commission on Accreditation of Health Care Organisations (JCAHO, 1988) as it will be of high volume and high risk which are vital components to being identified as a tracer situation. The two major musts to be identified as a tracer situation.


3.2.2 Spots of Quality Management

Risks, obstacles and facilitators of employing quality in organisations are discussed.

3.2.2.1 Risks
What you have to watch out for!

closing up the market
Applying quality management brings the danger that side-effects are taken advantage of. If quality is not taken seriously, interest groups involved can use quality standards as better freecards for closing up the market, freezing their beneficial status quo with means of 'quality assurance'. Allowing Refractive Surgery to be done by ophthalmologists would be rather a 'political decision', whereas strict training programmes and the selection of only the best skilled surgeons would be quality management. Both approaches lead to discrimination, although in the second its only a result and not an unspoken aim.

scientist's dogma
If quality indicators are set by authorities, and are not evaluated through 'democratic' patient research and questionnaires then they are probably not representative. The set of quality indicators will either be to small or will not correlate to the satisfaction of the patients. In this case, quality management will present a danger, and might become an end in itself. Techniques which bring best results in typical clinical testing, but bring poor vision results at night, will not be questioned or even discovered at the time. Optimising the surgeries outcome to undesired targets will not be for the benefit of the patient. It produces additional procedures leading to patient discomfort and additional costs.

lowering risk by lowering goals
Lowering the risk of unsuccessful surgery might be achieved by simplifying the surgery. However, in some circumstances this -lowering responsibility- might lower the outcome of successful surgery. Lowering the risk potential by lowering precision might be a solution. However, combined with other interests this could lead off from the best track to minor results in the future. Missing training programs and the lack of skilled surgeons for the LASIK procedure could lead to further support for PRK instead of bettering the LASIK procedure.

 

 

 
 
 
 
 

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