Quality Improvement Method

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The American health care system has serious

problems with quality and safety. One effective

way to attack these problems is through the

methods of quality improvement (QI). Over the

past several decades, the American healthcare

system has moved from a quality assurance

(QA) model to one focused on qualityimprovement (QI). The difference between the

two concepts is that QA models target currently

existing quality; QI models target ongoing and

continually improving quality.

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The term QI refers to activities that use

data-based methodssome developed in

manufacturing industriesto bring aboutimmediate improvements in health care

delivery. Change has always been an intrinsic

part of medical practice, as clinicians and

managers adapt to new medical knowledge,

new technology, and new patterns of

disease. QI methods enable them to make

change in a systematic way, measuring andassessing the effects of a change, feeding the

information back into the clinical setting,

and making adjustments until they are

satisfied with the results.

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Model for Quality Improvement

The Model for Improvement is a simple but powerful

framework for structuring any quality improvement

project. First, every project should be able to answer

three fundamental questions:

1. What are we trying to accomplish?

This question is meant to establish an aim statementfor improvement and focuses the organizations effort.

The aim statement should be time specific, measurable

and as concise as possible. It helps to focus on specific

actions or elements of the Care Model and to definewhich patients and providers will participate.

2. How will we know a change is an improvement?

Measures and definitions are necessary to assess and

understand the impact of changes designed to meet theaim.

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When shared aims and data are used, learning is further

enhanced because it can be shared with other

organizations. In this way, superior performance and

best practices are more quickly identified anddisseminated through benchmarking.

3. What changes can we make that could lead to an

improvement?

Testing by way of the Plan-Do-Study-Act cycle is

necessary to conclude that a result is an improvement.

The P-D-S-A cycle is a trial-and-learning method to

discover what is an effective and efficient way to change

a process. Studying the cycle is analyzing the outcomemeasurements and deciding if the intervention was an

effective and efficient way to change a process. The

cycle is modified and repeated as necessary until the

change is ready for broader implementation.

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Second, quality improvement teams should test their

ideas for improvement in small but frequent tests of

change, using Plan-Do-Study-Act (PDSA) cycles.

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This is the original QI model

based on the Plan-Do-Study-Act

(PDSA) cycle. TQM, also referred to

as Continuous Quality Improvement

(CQI), is a philosophy developed by

Dr. W. Edwards Deming

Two models that emphasize the ongoing nature of QI

include total quality management (TQM) and the Toyota

Production System (TPS).

Total Quality Management (TQM)

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Dr. W. Edwards Deming:(October 14, 1900 December

20, 1993) was an American

statistician, professor, author,

lecturer and consultant,

considered the Father of theModern Quality. Edwards

Deming strongly influenced

Japanese industry post WWII

with Statistical ProcessControl (SPC) and Total Quality

Management (TQM)

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TQM is one of the hallmarks of

Japanese management systems. It

assumes that production and service

focus on the individual and that

quality can always be better. Thus,

identifying and doing the right

things, the right way, the first time

and problem-prevention planningnot inspection and reactive problem

solvinglead to quality outcomes.

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Because TQM is a never-ending process,everything and everyone in the organization

are subject to continuous improvement

efforts. No matter how good the product or

service is, the TQM philosophy says that

there is always room for improvement.

Customer needs and experiences with the

product are constantly evaluated.

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Workersnot a central QA/QI department

do this data collection, thus providing a

feedback loop between administrators,

workers, and consumers. Any problems

encountered are approached in a preventive

or proactive mode so that crisis management

becomes unnecessary.

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Another critical component of TQM is the

empowerment of employees by providing positive

feedback and reinforcing attitudes and behaviors that

support quality and productivity. Based on the premise

that employees have an in-depth understanding of

their jobs, believe they are valued, and feel encouraged

to improve product or service quality through risk-

taking and creativity, TQM trusts the employees to be

knowledgeable, accountable, and responsible andprovides education and training for employees at all

levels.

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Although the philosophy of TQM

emphasizes that quality is more important

than profit, the resultant increase in quality

of a well-implemented TQM program

attracts more customers, resulting in

increased profit margins and a financially

healthier organization.

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1) Create a constancy of purpose for theimprovement of products and service.

2) Adopt a philosophy of continual

improvement.

3) Focus on improving processes, not oninspection of product.

4) End the practice of awarding business on

price alone; instead, minimize total cost by

working with a single supplier.5) Constantly improve every process for

planning, production, and service.

6) Institute job training and retraining.

7) Develop the leadership in the organization.

14 Total Quality Management Principles of TQM

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8) Drive out fear by encouraging employees to

participate actively in the process.

9) Foster interdepartmental cooperation, and

break down barriers between departments.10) Eliminate slogans, exhortations, and targets

for the workforce.

11) Focus on quality and not just quantity;

eliminate quota systems if they are inplace.

12) Promote teamwork rather than individual

accomplishments. Eliminate the annual

rating or merit system.13) Educate/train employees to maximize

personal development.

14) Charge all employees with carrying out the

total quality management package.

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Another more contemporary,customer-focused quality

improvement model is the

Toyota Production System

(TPS). TPS is a production

system built on the complete

elimination of waste and

focused on the pursuit of themost efficient production

method possible (Toyota

Motor Company, 2010).

The Toyota Production System

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Lean thinking, which was developed by Toyota in

the 1950s, aims to achieve waste reduction and

efficiency while simultaneously improving product

quality. The core principle in lean thinking is the

need to provide what the internal or external

customer wants, i.e., to provide value to the

customer, with minimal wasted time, effort, and

cost. Correcting or removing any actions or

processes that do not create value (i.e., waste) will

lead to additional capacity and hence enhanced

performance.

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Healthcare organizations that use

TPS would have caregivers not only

attempt to directly solve problems at thetime they occur, but it would also have

them determine the root cause of the

problem, so that the likelihood of the

problem recurring would be minimized.TPS argues that solving individual

problems this way, one at a time and

where,when, and with whom they occur,

prevents larger problems. Thus,management decisions are based on a

long-term philosophy, even at the

expense of short-term financial goals.

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Implementing TPS, however, is not

easy. It usually requires a change in

organizational culture, values, and rolessince responsibility and accountability

for solving problems is sodecentralized.

In addition, eliminating problems at

their root is far different from solving an

immediate problem at hand. Thus,

adopting TPS in an organization requires

a substantial commitment of leadershiptime and resources. It also requires a

tremendous amount of staffpreparation

and involvement.