Total quality management

While there are many definitions of TQM, they all share the common perspective of it being a philosophy rather than a simple management procedure. It must be seen as a process of improvement beyond the status quo that then extends into an all-encompassing program of developing, and fostering, the desire for change and improvement throughout the entire organization. TQM is an all-encompassing quality system, it includes QC, QA and QI within a perpetual reiterative process, but it is still based upon the foundations of inspection and audit (see Figure 3.2). TQM must be seen as a long-term goal, there are no short cuts or quick fixes in implementing TQM. There is no tool or technique that can be seen as a panacea for all the problems and woes of an organization, no turn-key systems that can be plugged into an organization's pre-existing management structure. Achieving a system of continuous improvement can take years, depending on the nature and size of the organization: time frames of 8 to 10 years have been suggested for big corporations, although from experience the more limited nature of even a big IVF Center can allow success within 2 or 3 years.

TQM in IVF can be seen as encompassing the following areas of a Center's operation, all of which impinge upon the laboratory.

Total Quality Management

Figure 3.2 A diagrammatic overview of Total Quality Management.

Medical and scientific standards

Obviously the latest and best techniques and protocols are required to enable the medical and laboratory staff to provide the highest quality services to patients. This can be summed up as striving to achieve "best practice." Responsibility

Everyone involved in IVF must have a sense of responsibility for their actions. The fundamental principle of medicine, primum non nocere or "first do no harm" must always be uppermost in everyone's minds. Duty of care

There is a clear, and inescapable, duty of care towards not just the patients being treated, but also to the future children who will be created by successful treatment. Ethics

A great deal has been written and said about ethics in assisted reproduction technology, which ranges from simple artificial insemination on the one hand to reproductive cloning on the other. The vast majority ofpractitioners, both medical and scientific, have extremely high ethical standards, but it only takes the odd person who is determined to challenge society, or "push the envelope," to create headlines and bring everyone else under suspicion. Ethics must be seen as existing at several levels:

• Personal ethics, which can be moral or religious (although these can be considered more as "beliefs" that do not necessarily have any foundation in science);

• Professional ethics, often consisting of codes of conduct or recommendations for good practice produced by professional bodies; and

• Society also has ethical perspectives, and these are embodied in the requirement for ethics committees or institutional review boards -which can be seen as either a normal obligation stemming from our existence within a developed society or as a requirement imposed by regulatory bodies.

Pregnancy Guide

Pregnancy Guide

A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

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