Healthcare Quality Improvement The Quality Foundation
To better understand and appreciate quality improvement systems and theories used today, we should be familiar with the origin of these principles and the foundation that has shaped their current existence. So here we discuss some of those influential contributors and thought leaders of quality improvement systems and theories intent on improving the process and producing sustainable quality results at highly productive levels. These leaders include:
W. Edwards Deming;
Joseph M. Juran;
Armand V. Feigenbaum; and
Philip B. Crosby
Shewhart introduced the concepts of common cause, special cause variation, and statistical control.
Deming stressed the importance of practicing continual improvement and thinking of manufacturing as a system. He described the Plan-Do-Study-Act cycle, which can be traced to Shewhart.
Joseph M. Juran
Juran’s more notable contributions to the quality improvement is known as the “Juran Trilogy” The trilogy describes three interrelated processes: quality planning, quality control, and quality improvement.
Ohno created a standardized system that completes one product at a time, ultimately producing less waste, greater efficiency, and higher output.
Ishikawa’s more notable contributions to the quality improvement were the creation of the Ishikawa diagram (fishbone diagram).
Armand V. Feigenbaum
Feigenbaum approached quality as a strategic business tool that requires awareness by everyone in the company.
Philip B. Crosby
Crosby introduced the idea of zero defects in 1961. He defined quality as “conformance to requirements” and measured quality as the “price of nonconformance”.
Quality Improvement Processes
This section describes some of the many systems and process that guide quality
improvement efforts today. These quality improvement approaches are derivatives and models of the ideas and theories developed by thought leaders and include:
Walter Shewhart developed the Plan-Do-Check-Act cycle used as the basis for
planning and directing performance improvement efforts.
Associates for process improvement’s (API)
API model contains three fundamental questions that form the basis for improvement:
What are we trying to accomplish? How will we know that a change is an
improvement? What change can we make that will result in improvement?
The key feature of FOCUS PDCA is the preexistence of a process that needs
improvement. The intent of this model is to maximize the performance of a
preexisting process, although the inclusion of PDCA provides the option of using this model for new or redesign projects.
The Baldrige criteria were originally developed and applied to businesses; healthcare specific criteria were created to help healthcare organizations address challenges such as focusing on core competencies, introducing new technologies, reducing costs, communication and sharing information electronically, establishing new alliances with health care providers, and maintaining market advantage.
The International Organization for Standardization (ISO)made major changes to the standards to make them more relevant to service and healthcare settings focused more on quality management systems, process approach, and the role of top management.
The term “Lean” was developed to describe production methods and product
development that, when compared to traditional mass production processes, produce more products, with fewer defects, in a shorter time.
Six Sigma (3.4 defects per million) is a system for improvement developed over the time. The aim of Six Sigma is to reduce variation in a key business process.
A control chart consists of chronological data along with upper and lower control boundaries that define the limits of common cause variations.
A histogram is a graphical display of the frequency distribution of the quality characteristic of interest.
Cause-and-Effect/ Fishbone Diagram
In a cause-and-effect diagram, the problem (effect) is stated in a box on the right side of the chart, and likely causes are listed around major headings (bones) that lead to the effect.
Pareto principle found that 80 percent of the variation of any characteristic is caused by only 20 percent of the possible variables.
A list of ideas created, and then individual idea is written on small note cards. Team members study the cards and group the ideas into common categories.
The Matrix Diagram helps us to answer two important questions when the sets of data are compared: Are the data related? How strong is the relationship?
Groups can use priorities matrix to systematically discuss, identify, and prioritize the criteria that have the most influence on the decision and study the possibilities.
Benchmarking compares the processes and successes of the competitors or of similar top performing organizations to our current processes.
Failure Mode and Effects Analysis
(FMEA) examines potential problems and their causes and predicts undesired results.