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“How does the system work?” — answered by the question mark “Does it create problems?” — likely to be – Yes “Do people understand them?” — likely to be – No An effective Quality Improvement programme requires total commitment from employees and this is best effected through a totally committed leadership. This can be managers or it may be employees working in teams on identified quality issues.
It is envisaged that a commitment to change to a standardisation of systems within the OACMHT would actually be fostered naturally during this initial diagnostic stage where individuals at all levels would develop an awareness and understanding of the issues involved. Involvement and participation would be covered during individual and group employee interviews, workshops, brainstorming sessions and the provision of means where employees could make written record of specific issues surrounding the area of standardisation. Communication during this phase would be open to all in the team, both verbal and written. Commitment would be generated where members feel a sense of involvement in the decision making process through a sharing of information.
Next stage would include the development of statements, which would indicate the end of the means. It would be formulated by an examination of where the team is now in relation to understanding systems and procedures, and where the team would like to be in the future, focusing particularly on standards, values and beliefs. The statements of vision need to be clear, unequivocal and attainable in the eyes of members.

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Implementation would incorporate education and training and would require assignation of responsibility to carry the idea forward consisting of a small multi-disciplinary/agency group within the OACMHT. This group would be involved initially in the formalisation of a communications system providing news of progress, changes or initiatives. It would also have a remit to organise staff training both in aspects of Total Quality Management and in developments during its process e.g. a training programme on financial assessment, which may involve external trainers. Another example may be general workshops on role clarification both as an individual member and as an integral part of the OACMHT.
The group would develop Quality Improvement Plans based on information gathered from team members during the diagnostic stage and information gained from an open communication system where formal and informal feedback is welcomed. The quality improvement plans would be seen as standards set in relation to priorities identified. Monitoring and Evaluation of effectiveness of the system would also involve regular meetings with team members to ascertain qualitative feedback, and also by development, through consultation with team members, of auditing documentation as a means of quantitative evaluation.
Time scales for development of a Total Quality Management programme must be realistic and flexible and cannot be defined at this time for this particular project, however equal emphasis would be placed on each stage of the process. In conclusion, introduction of a Total Quality Management system within any area requires meticulous planning through informed information gathering exercises utilising recognised tools and techniques.
Employee involvement from the top down is a crucial factor in determining both initial and continuing success. A clear statement of intent is vital as are the definition of goals. Further components would also include employee empowerment and a focus on a rolling programme of training, and a constant evaluation of achievements, building on successes and learning from mistakes. Underpinning and critical to all of this is a central theme of continual two way communication at all levels within the team, ensuring a successful constant of change.

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