Quality

• Degree of adherence to pre-established criteria or standards.

• Not an easy subject to get quality healthcare services.

Quality management

• Doing the right thing, at the right time, for the right person,
and having the best quality result.
• 4 main components:
• Quality planning
• Quality control
• Quality assurance
• Quality improvement
• Focused on product/service quality & means to achieve it
• .. According to Jamshidian and Shahin (2004) and Dale (1994), quality
management system has expanded rapidly in recent years to improve
its performance
• over the past two decades, the simple inspection activities have been
complemented by quality control and have been developed by QA
• Now most companies are moving towards TQM.
• Four essential components can be expected for the quality
management system; so that it can be possible to reach TQM system
from inspection in three stages of growth and development. ...
1. QUALITY PLANNING
Art of quality management focused on setting quality objectives
and specifying necessary operational processes and related
resources to fulfill quality objectives.
2- QUALITY CONTROL (QC)
The operational techniques & activities aimed both at monitoring a
process & eliminating causes of unsatisfactory performance or
relevant stages of the quality loop (quality spiral) in order to result
in economic effectiveness.
 3- QUALITY ASSURANCE (QA)
 Contains all the planned & systematic actions required to provide
adequate confidence that a product or service will satisfy given
requirements for quality.
 Part of quality management focused on providing confidence that
quality requirements will be fulfilled.
 Broad concept that focuses on the entire quality system including
suppliers and ultimate consumers of the product or service.
 QC VS QA
Both are a set of activities for ensuring quality of the process (QA) &
the product after being produced (QC).

Quality Control Quality

Assurance
• Set of activities for ensuring • Set of activities ensuring
quality
for in products. The activities quality in the processes by which
focus on identifying defects in the products or services are developed.
actual products produced. • Proactive process aiming to
• Reactive process aims to identify prevent defects.
(& correct) defects in the finished • Goal: improve development & test
product. processes so that defects do not
• Goal: identify defects after a arise when the product is being
product is developed & before it's developed.
released
4. QUALITY IMPROVEMENT (QI)
 Part of quality management focused on ↑ ability to fulfill quality
requirements.
 Any action taken to ↑ value to the customer or other stakeholder
by improving effectiveness & efficiency of processes and
activities throughout the organization.

QI is a management process and set of tools & techniques that are

coordinated to ensure that departments consistently meet the health
needs of their communities.
 STEPS FOR QI:

Set standards Monitoring of

Communicate implementation;
• Practice guidelines.
Develop a plan with • Administrative procedure
standards for the Auditing.
SMART • Responsibilities people concerned to
• Identify problems &
objectives. • Performance standards conform to. put priorities (Pareto
technique)

Analyze problem to
identify root
Choosing a team to causes (data Develop solutions &
Define the problems collection, analysis
solve the problem. actions for QI.
& presentation,
Fish- bone
diagram).

Repeat the cycle after

Implement & evaluate
success in another
QI efforts.
area.
5. TOTAL QUALITY MANAGEMENT (TQM)
 Approach which promised to both ↑ quality & ↓ costs
• Comprehensive management of service processes aiming to:
• Maintain a desired level of excellence.
• Ensure complete customer satisfaction at every internally and
stage, externally, the 1st time and every time.
• Includes implementing of: QA & QC & QI.

• Focuses on preventive measures, not detection of problems i.e.

proactive rather than reactive actions.

• Ensures quality standards from the beginning and in every step

(planning, implementation, supervision and output).
 The Era of Quality Gurus
There have been three groups of gurus since the 1940’s:

Early 1950’s: Americans who took the messages of quality to

Japan

Late 1950’s: Japanese who developed new concepts in

response to the Americans

1970’s-1980’s: Western gurus who followed the Japanese

industrial success
 Total Quality Management (TQM)
The Americans who went to Japan:

J. Edward Deming Joseph M. Juran Armand V Feigenbaum

Total Quality Management (TQM)
Joseph Juran
Juran is a founder of the Juran Institute in Wilton, Connecticut.
He promoted the concept known as Business Process Quality,
which is a technique of Cross-Functional Quality Improvement.

He was invited to Japan in 1954 by the Union of Japanese

Scientists and Engineers (JUSE)

He predicted the quality of Japanese goods would overtake the

quality of goods produced in US by Mid-1970s because of
Japan’s revolutionary rate of quality improvement
Total Quality Management (TQM)
W. Edward Deming
Deming, who had become frustrated with American managers when most programs of
statistical quality control were terminated once the war and government contracts came
to an end, was invited to Japan in 1954 by the Union of Japanese Scientists and
Engineers (JUSE).

Deming was the main figure in popularizing quality control in Japan and regarded as
national hero in that country.

He believes that quality must be built I into the product at all stages in order to achieve
a high level of excellence.

His thoughts were highly influenced by Walter Shwartz who was the proponent of
Statistical Quality Control (SQC). He views statistics as a management tool and relies on
statistical process control as means in managing variations in a process.
 Total Quality Management (TQM)
W Edwards Deming placed great importance and responsibility on management, at both the individual and
company level, believing management to be responsible for 94% of quality problems. His fourteen point
plan is a complete philosophy of management, that can be applied to small or large organizations in the
public, private or service sectors:

1. Create constancy of purpose towards improvement of product and service

2. Adopt the new philosophy. We can no longer live with commonly accepted levels of delay, mistakes
and defective workmanship
3. Cease dependence on mass inspection. Instead, require statistical evidence that quality is built in
4. End the practice of awarding business on the basis of price
5. Find problems. It is management’s job to work continually on the system
6. Institute modern methods of training on the job
7. Institute modern methods of supervision of production workers, The responsibility of foremen must
be changed from numbers to quality
8. Drive out fear, so that everyone may work effectively for the company
9. Break down barriers between departments
10. Eliminate numerical goals, posters and slogans for the workforce asking for new levels of productivity without
providing methods
11. Eliminate work standards that prescribe numerical quotas
12. Remove barriers that stand between the hourly worker and their right to pride of workmanship
13. Institute a vigorous program of education and retraining
14. Create a structure in top management that will push on the above points every day
Total Quality Management (TQM)
Armand V Feigenbaum was the originator of “total quality
control”, often referred to as total quality.

He defined it as:
“An effective system for integrating quality
development, quality maintenance and quality
improvement efforts of the various groups within an
organization, so as to enable production and
service at the most economical levels that allow full
customer satisfaction”.

He saw it as a business method and proposed three steps to

quality:
• Quality leadership
• Modern quality technology
• Organisational commitment
 Total Quality Management (TQM)
Japanese who developed new concepts in response to the Americans

Dr Kaoru Ishikawa Dr Genichi Taguchi Shigeo Shingo

Dr Kaoru Ishikawa made many contributions to quality, the most noteworthy being his total
quality viewpoint, company wide quality control, his emphasis on the human side of quality, the
Ishikawa diagram and the assembly and use of the “seven basic tools of quality”:

– Pareto analysis which are the big problems?

– Cause and effect diagrams what causes the problems?
– Stratification how is the data made up?
– Check sheets how often it occurs or is done?
– Histograms what do overall variations look
like?
– Scatter charts what are the relationships
between factors?
– Process control charts which variations to control and
how?
 Total Quality Management (TQM)
Ishikawa Diagram (Cause & Effects Diagram)
Also known as Fishbone Analysis
Total Quality Management (TQM)

Shigeo Shingo
Shingo is strongly associated with Just-in-Time manufacturing,
and was the inventor of the single minute exchange of die
(SMED) system, in which set up times are reduced from
hours to minutes, and the Poka-Yoke (mistake proofing)
system.

In Poka Yoke, defects are examined, the production system

stopped and immediate feedback given so that the root
causes of the problem may be identified and prevented from
occurring again.
Total Quality Management (TQM)
Dr Genichi Taguchi
Taguchi believed it is preferable to design product that is robust
or insensitive to variation in the manufacturing process, rather
than attempt to control all the many variations during actual
manufacture.

“Taguchi methodology” is fundamentally a prototyping method

that enables the designer to identify the optimal settings to
produce a robust product that can survive manufacturing time
after time, piece after piece, and provide what the customer
wants.
 Total Quality Management (TQM)
Western gurus who followed the Japanese industrial success

Philip B Crosby Tom Peters

Total Quality Management (TQM)
Philip B Crosby

Crosby is known for the concepts of “Quality is Free” and “Zero

Defects”, and his quality improvement process is based on his four
absolutes of quality:

– Quality is conformance to requirements

– The system of quality is prevention

– The performance standard is zero defect

– The measurement of quality is the price of non-

conformance
Problem solving and process improvement
techniques of QM