recently was the approval of a Total Quality Management (TQM) programme, according to Chairman of the Bermuda Hospitals Board, Mr. Robert Tucker and Executive Director of the Bermuda Hospitals Board, Mr. Hume Martin.

Total Quality Management involves a strengthened commitment to all customers, both internal and external, and maximises employee input in efforts to continuously improve the services of the Hospital.

Admitting and quality assurance manager, Mr. Aldwyn Savery defines the programme as "a set of philosophies and methods used by an organisation to guide it in continual improvement in all aspects of its' operations.'' And according to Mr. Savery, TQM focuses primarily on processes and systems that contribute to detract from customer satisfaction. "By focusing on processes and systems, quality activities can be directed at reducing complexities of these processes and improving efficiency,'' he said. "And controlling processes in this way generates opportunities to prevent errors and maximise improvement initiatives.'' The Total Quality Management programme will integrate the activities of quality assurance, risk management and utilisation management. And by integrating the processes, "it is hoped that a multidisciplinary monitoring and reporting quality system will be created, which would highlight improvement on input processes, and outcome of care and services within the hospitals,'' said Mr. Savery.

In order for the TQM discipline to be effective, Mr. Savery suggested that every individual, department and service make a commitment to support the process. "Our aim must be to ensure quality is: an integral part of our everyday practise; continuous and a permanent feature of our endeavours; comprehensive, involving all activities and staff; and systematic and reinforced by reliable monitoring.'' Training of large numbers of staff at King Edward VII Memorial Hospital and St. Brendan's Hospital in the philosophy and techniques of TQM has been a major achievement. And ongoing training of management and other levels of staff will continue.

As ombudsman and quality assurance manager, Mr. Savery receives any complaints from the public as well as internal patients. "I will review complaints and attempt to resolve them by working with department heads,'' he said. And he handles all complaints directly with the Chief of Staff as well as the Executive Director, which "cuts out all the red tape.'' If Mr. Savery cannot remedy the problem, he'll invite the person involved to suggest other courses of possible action. "And we're able to resolve about 95 percent of the complaints satisfactorily,'' he said.

Complaints vary in discipline. "They range from environmental problems and billing to the treatment of patients,'' said Mr. Savery. "But there are very few which can't be resolved. 1993 saw 130 complaints. And only three haven't been resolved,'' he said.

When a problem is taken care of, the department heads review procedures as a result of that complaint. "This gives the consumer more say as to the running of the Hospital,'' said Mr. Savery.

The Total Quality Management Programme, which began in July 1992, was designed following the concepts of American quality gurus. "In 1984 when the quality assurance programme started, we didn't want to hear the gripes,'' said Mr.

Savery. "But now with TQM, we welcome complaints because it only benefits and improves Hospital care.

"It also gets the community involved and shows us how we're doing as a health care facility,'' he said.

One specific concept adopted from American quality advisers is that of customer focus. "We define a customer as anyone who uses our service,'' said Mr. Savery. "And customer focus implies that staff give better services to the customer as well as improve their relationships with them.'' Recently the Hospital had a complaint about cockroaches in the wards. "We set up a pest control programme, which included the manager of the Bermuda Pest Control, to alleviate the problem,'' said Mr. Savery. "The group lasted five months and the project was very successful.'' Quality assurance activities for the past decade like infection control, utilisation reviews, auditing, and policies and procedures are still in place, according to Mr. Savery. "But we're embracing a different approach to them.

Now we view quality assurance activities as tools to quality management. And we try to be more proactive.'' "We've had to change the idea of how we view quality. And to produce quality goods, we must put ourselves in the customer's place. We try to make use of Hospital questionnaires.

"And we ask staff to continuously think of ways to improve services. We also use statistical tools such as charts, graphs and other supportive data,'' Mr.

Savery said.

The Quality Assurance Department is currently developing a programme where everyone in the Hospital knows exactly how the Board wants customers to be treated.

"The plan would document the sort of responsibility and dignity that should be standard of the staff,'' said Mr. Savery. "Most of the time clients complain about employee attitudes rather than the treatment. The custom in Bermuda is friendliness. And we must give customers that -- it's what they want and what they're used to,'' he said.

"We are a long way from reporting any big successes with the Total Quality Management programme,'' said Mr. Savery. "But Hospital staff are more responsive to our patients.

"And if we ever have a big complaint, we not only write back to the person objecting, we invite them to come in and talk with us,'' he added. "We want to form a working partnership with people in the community.'' And the staff are constantly reminded of this. Since 1984, every paycheque states the `patient is the reason we are here.'