Table 7 Definition of implementation and intensity for QI methods in hospital

TQM- QIT

The Quality Improvement Team (QIT) must train a team leader and a facilitator, follow any standard quality improvement process (e.g. ROADMAP), meet regularly and frequently, and be approved by top administration [36].

One cycle of hospital-wide QIT was done in different topics, with or without public demonstration.

QCC

Quality Circle is made up of volunteers, who meet at least once a week and follow the P-D-C-A principle including 10 steps for problem solving and/or process improvement [36]

One cycle of QCC contest was finished hospital-wide or in specific departments (such as nursing department), with or without public demonstration.

ISO certification

Hospitals invite an outside expert or a consulting company to provide ISO 9000 or other types of ISO training. Its purpose is to obtain external certification of both internal audit and external audit processes [36]

Any form of ISO certification was provided by an external agency, including the ISO 9000 series, ISO 14000, ISO 22000, ISO 25000, etc.

Employee Suggestion

Hospital seeks employees’ ideas for improvement and provides financial rewards to employees who contribute to a formal review and feedback process [36]

At least one cycle of employee suggestion was finished by adopting or rejecting suggestions as well as giving financial reward.

Process Reengineering

Fundamental rethinking and radical redesign to get a dramatic improvement in major processes [37]

At least one project done following the idea of process reengineering in hospital.

5S

Apply Seiri, Sesieon, Seisu, Seiketsu, and Shotsuke hospital-wide or in specific departments [38]

Hospital provides information about the scope of 5S implementation and number of internal contests.

Learning Organization

Learning Organization is defined as an organization that is good at creating, acquiring, and disseminating knowledge. The organization also applies those knowledge and ideas to change behavior [39]

Hospital provides information about specific activities in Learning Organization.

Six Sigma

Six Sigma project team is comprised of several types of individual, such as champions, master black belt, black belt, green belt and team members [40]

Apply the DMAIC (define, measure, analysis, improve, control) steps to finish at least one Six Sigma project.

Benchmarking

Benchmarking is defined as “measuring your performance against that of best-in-class companies; determining how the best-in-class achieve those performance levels; and using the information as a basis for our own hospital’s target [40]

Hospital provides support to organize Benchmarking team in different departments and/or number of teams in different periods with or without public demonstration.

Hoshin Planning

Hoshin Planning is a combination of strategic planning and policy deployment throughout the organization. It focuses on key systems that need to be improved to achieve strategic objectives. It requires the participation and coordination by all levels and departments as appropriate in the planning, deployment of yearly objectives and means. Goal and action plans cascade through the organization based on the true capability of the organization [41]

Hospital provides evidence of finishing basic strategic objectives, annual objective and strategy, and action plan in cascading units.

Quality Function Deployment

Quality Function Deployment is a formalized process to listen to the voice of the customer and should be tailored to specific situations [36]

Hospital demonstrates the topic that applies QFD for transforming a patient’s need into service.

Patient Satisfaction Survey

Patient Satisfaction is the outcome of providing value that meets or does not meet the patient’s need in that situation [42]. Hospitals can use it to improve the services that patients are not satisfied with.

Hospital performs patient survey in ambulatory, inpatient, emergency care or any other services.

Employee Satisfaction Survey

Employee Satisfaction is the outcome of providing value that meets or does not meet the employee’s need in that situation [42]. Hospitals can use it to improve the working environment/ condition which Employees are not satisfied with.

Hospital performs employee survey at least once.

Service Quality Improvement

Any method that improves patient perception of reliability, assurance, tangibles, empathy, and responsiveness [40]

Hospital uses different methods for service quality improvement such as offering ritual training and establishing patient complaint center, etc.

Clinical Pathway

Clinical Pathways (critical pathways) are schedules for medical, nursing and other hospital staff, including tests, medications, and consultations designed to improve the efficiency of a coordinated program of treatment [43]

Hospital reports the number of formally developed clinical pathways, and/or the number of clinical pathways with online support from the information system.

Evidence-based Medicine

Evidence-based Medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients [44]

The scope and mode of implementation of EBM in a hospital. Any kind of evidence to support implementation in specific departments or set up of an EBM center, etc.

Quality Indicator Systems

Quality Indicator System is a performance measurement system that represents a system of analyses and control support based on system analysis of the environment and process taking place therein; definition of accurate and standardized methods of data collection and measurement; definition of key indicators; and providing feedback information to participants [43], and participants can use it to compare their performance with peers and initiate following QI activitiescc

Hospital joins the TQIP (IQIP in Taiwan) with evidence of reporting acute care, long-term care or psychiatric care indicators [45]. Hospital joins the THIS with evidence of reporting ambulatory, inpatient, emergency, ICU, patient safety indicators [46].

Breakthrough Collaborative

The most well-known approach is the “Breakthrough” model developed by the Institute for Healthcare Improvement (IHI). A quality improvement project team which is not part of a collaboration—a “traditional QI team”—uses similar methods to plan and test changes but chooses its own problem and spends time working on diagnosing the problem and analyzing causes before planning and testing changes [47].

Hospital attends these activities held by TJCHA with program charter and specific goal setting and presents progress results three times.