Download QUALITY MANAGEMENT

QUALITY DEFINITION
Dr. Nasser Ali Al-Jar Allah
Quality Definition
“ Quality is often used to signify
‘excellence’ of a product or
service ”.
 “ meeting the customer
requirements ”.

Quality Definition

It is important to define quality
in words that are useful in its
management and study
because nothing can be
improved unless it has been
clearly defined and can be
measured.
Quality Definition
Three American quality experts
introduced approaches to define
and manage quality
 These are the approaches of
Philip B. Crosby, W. Edwards
Deming, and Joseph M. Juran

Crosby

A.
B.
C.
D.
introduced four absolutes of quality,
these are :
the quality definition is ‘conformance to
requirements’
the quality system is ‘preventive
the performance standard is ‘zero defects’
the measurement to be made is ‘the price of non-
conformance’
Crosby

1.
2.
3.
Crosby offers fourteen steps to
management improvement:
Make it clear that management is committed to
quality.
Form quality improvement teams with
representatives from each department.
Determine where correct and potential quality
problems lie.
Crosby
4.
5.
6.
7.
Evaluate the cost of quality and explain its use as a
management tool.
Raise quality awareness and the personal concern
of all employees.
Take actions to correct problems identified through
the previous steps.
Establish a committee for the zero defects program.
Crosby
8.
9.
10.
11.
Train supervisors to actively carry out their part of
the quality improvement program.
Hold a ‘zero defects day’ to let all employees realize
that there has been a change.
Encourage individuals to establish improvement
goals for themselves and their groups.
Encourage employees to communicate to
management the obstacles they face in attaining
their improvement goals.
Crosby
12.
13.
14.
Recognize and appreciate those who participate.
Establish quality councils to communicate on a
regular basis.
Do it all over again to emphasize that the quality
improvement program never ends.
Deming

1.
offers fourteen points for the
management of quality which are
the following:
Create constancy of purpose towards
improvement of product and service.
Deming
2.
3.
4.
Adopt the new philosophy. We can no
longer live with commonly accepted levels
of delays, mistakes, and defective
workmanship.
Cease dependence on mass inspection.
Require, instead, statistical evidence that
quality is built in.
End the practice of awarding business on
the basis of price tag.
Deming
5.
6.
Find problems. It is management’s job
to work continually on the system.
Institute modern methods of training
on the job.
Deming
7.
8.
9.
Institute modern methods of
supervision of production workers.
The responsibility of foremen must be
changed from numbers to quality.
Drive out fear, so that everyone may
work effectively for the company.
Break down barriers between
departments.
Deming
10.
11.
Eliminate numerical goals, posters and
slogans for the workforce asking for
new levels of productivity without
providing methods.
Eliminate work standards that
prescribe numerical quotas.
Deming
12.
13.
14.
Remove barriers that stand between
the hourly worker and his right to
pride of workmanship.
Institute a vigorous program of
education and retraining.
Create a structure in top management
that will push every day on the above
thirteen points
Juran

1.
2.
offers ten steps to quality improvement that
are the following:
Build awareness of the need and
opportunity for improvement.
Set goals for improvement.
Juran
3.
4.
5.
Organize to reach the goals (establish a
quality council, identify problems, select
projects, appoint teams, designate
facilitators).
Provide training.
Carry out projects to solve problems.
Juran
6.
7.
8.
9.
10.
Report progress.
Give recognition.
Communicate results.
Keep score.
Maintain momentum by making annual
improvement part of the regular
systems and processes of the company.
International Standardization
Organization (ISO)


develops and publishes internationally
standards for a wide range of products,
services and systems.
Standards published by ISO (and
subsequently by national standards
bodies such as ANSI (American National
Standards Institution) in the USA.
International Standardization
Organization (ISO)

the ISO's Quality Definition :
"the totality of features and
characteristics of a product or
service that bears on the ability
to satisfy stated or implied
needs."
International Standardization
Organization (ISO)

the three original documents,
ISO 9001, ISO 9002, ISO 9003,
are "requirements standards".
They still form the heart of the
series and generate the most
interest.
International Standardization
Organization (ISO)

These three standards, which
define a minimum framework of
requirements for the
development and
implementation of a quality
system.
International Standardization
Organization (ISO)
they are designed to be
verifiable standards for a quality
system in any industry sector.
 they are generic to all quality
(management) systems and are
non-technical in nature.

International Standardization
Organization (ISO)


They do not specify performance
(outcome) requirements or methods to
be implemented to attain them.
These requirements and methods must
be ascertained by the organization in
question and will be dependent on any
customer, regulatory, or internally
specified expectations.
International Standardization
Organization (ISO)

1.
2.
3.
4.
In late 2000, ISO 9000 re-design of
a new set of four main headings :
Management responsibility.
Resource management.
Process management.
Measurement and analysis
improvement.
What are the motives that
make us care about quality ?
Q.Why have
several
definitions ?
What are the motives that
make us care about quality ?
.Quality is a
multidimensional
and multifaceted
concept.
What are the motives that
make us care about quality ?
Q What are the motives
that make us care about
quality ?
1. First, the economic imperative for
quality where the "gurus" promise
that achieving quality will reduce
costs and improve productivity.
What are the motives that
make us care about quality ?
2. they explains the social imperative for
quality which stems from the
responsibility of all managers to
 minimize waste of costly human
resources.
 maximize satisfaction
through work for their colleagues in order to
support social cohesion within their own
sphere of influence.
What are the motives that
make us care about quality ?
3. It is the environmental imperative for
quality, by which the management
have the additional responsibility of
considering the total effectiveness of
the organization in terms of its use of
all resources and the environmental
impact and implications of the
organization they manage.
Al-Jar Allah definition of
quality

"Conformance to physical, mental,
and spiritual requirements of
individuals
and
organizations,
which leads to fitness with the
environment and nature as well as
fitness for use ”
Al-Jar Allah’s definition of
quality

Organizational quality is not only
determined by the fact that the
organization produces a product or
service which is fit for use, or conforms
to customer requirements but also
depends upon all of the aspects of the
relationships that the organization
makes with its environment.
QUALITY IN HEALTH CARE
Dr. Nasser Ali Al-Jar Allah
Quality in Health Care

Quality assurance dates to 2000
B.C. in the Code of King
Hammurabi of Babylon. Inscribed
on a block of diorite housed in the
Louvre Museum in Paris are the
earliest known documented
penalties for incompetent practice.
Quality in Health Care

The Code of Hammurabi also
contains the earliest known
listing of charges for service,
thereby incorporating the
quality and cost of medical
care.
Quality in Health Care

The quality assurance
activities began with the
Joint Commission on
Accreditation of Hospitals
in the 1960s and 1970s.
PATIENT-FOCUSED FUNCTIONS
Patient Rights and
Organizational Ethics
Patient Rights
Organizatiol Ethics
Assessment of Patients
Initial Assessment
Pathology and Clinical Laboratory
Services-Waived Tasking
Reassessment
Care Decisions
Structure Supporting the
Assessment of Patients
Additional Requirements for
Specific Patient Populations
Care of Patients
Planning and Providing Care
Anesthesia Care
Medication Use
Nutrition Care
Operative and Oher Procedures
Rehabilitation Care and Services
Special Treatment Procedures
Education
Patient and Family Education and
Responsibilities
Continuum Care
Continuity of Care
ORGANIZATION FUNCTIONS
ORGANIZATION FUNCTIONS
CONTINUED
Improving Organization
Performance
Plan
Design
Measure
Assess
Improve
Management of Information
Leadership
Planning
Directing Departments
Integrating and Coordinating
Services
Role in improving performance
Surveillance, Prevention
and Control of Infection
Surveillance, Prevention
and Control of Infection
Management of the
Environment of Care
Design
Implementation
Measuring Outcomes of
Implementation
Social Environment
Management of
Human Resources
Human Resources Planning
Orienting, Training, and
Educating Staff
Assessing Competence
Managing Staff Requests
Information Management Planning
Patient-Specific Data and Information
Aggregate Data and Information
Knowledge-Based Information
Comparative Data and Information
STRUCTURES WITH
FUNCTIONS
Governance
Governance
Management
Management
Medical Staff
Organization, Bylaws, Rules, and
Regulations
Credentialing
Nursing
Nursing
Special Type I recommendation(s)
1
2
3
4
5
N
P
=
=
=
=
=
=
=
Substantial Compliance
Significant Compliance
Partial Compliance
Minimal Compliance
Non-compliance
Not Applicable
Defer to Primary Service
Summary Grid Score = ________
Quality in Health Care

There has been a widespread
acceptance of the need for quality
management principles in
healthcare where the cornerstone
in providing quality services is in
considering the patient and his
satisfaction.
Quality in Health Care


The application of Deming’s
principles is easier in health care
than many other customer oriented
services, because it deals directly
with life or Quality of Life.
Doctors pioneered the development
of Quality Assurance.
Quality in Health Care

1.
2.
For example :seven decades ago, The American College
of Surgeons recommended that all
surgically removed tissues be routinely
reviewed by peers.
clinical laboratories in hospitals have
maintained accuracy controls for diagnostic
tests for long time.
Quality in Health Care

1.
2.
Why quality in health care is more
important today ?
In order to survive and remain
competitive in today’s business
climate.
the requirements and expectations of
all interested parties must be
identified and met.
Quality in Health Care
Additionally, health care
organizations must provide
consumers and other interested
parties with assurance that
products and services delivered
will meet or exceed their
expectations.
Quality in Health Care

1.
2.
3.
Health care quality
improvement focuses on the :improvement of quality.
increased productivity .
more competitive edge in the
health care marketplace.
Quality in Health Care

The health care industry faces
many challenges in the decades
ahead that require organizations
to respond quickly to the changes
in the market and the changes in
consumer needs.
Quality in Health Care

A.
B.
C.
D.
Such as:
aging population.
the uninsured. the changing role of
government.
technological and scientific advances.
increased competition and pressure to
be cost-effective.
Quality in Health Care

Each of these challenges places the
health care industry under extreme
pressure to



absorb budgetary constraints and
still achieve best practice at all levels.
This leaves health care providers,
suppliers, and consumers continuously
striving for quality.
Quality in Health Care

At first quality was largely
defined in terms of structural
shortcomings (buildings,
equipment, drugs and
supplies, staffing).
Quality in Health Care
focused on supplying and
increasing the quality of the
inputs.
 Inputs are quantifiable and poor
quality inputs can be costly to
end product or service quality.

Quality in Health Care


This approach may be appropriate for
large capital-intensive infrastructure
programs (roads, dams, and
telecommunications).
However it has little effect on human
resource programs that are laborintensive and deal with people that
provide and receive a personal service.
Quality in Health Care

The process by which inputs
are transformed into
outcomes and the desirability
of the outcomes are integral
parts of the quality
dimensions.
Quality in Health Care

1.
2.
3.
Measurement and
Determinants of quality :Definition.
norms and value judgments.
validity issue.
Quality in Health Care

The following four examples
of health care definitions
illustrate the evolution of
the thinking over the past
sixty years :-
Quality in Health Care
1.
“Good medical care is the kind of
medicine practiced and taught by the
recognized leaders of the medical
profession at a given time or period of
social, cultural, and professional
development in a community or
population group”.
Quality in Health Care
2.
“Standards of quality of care should be
based on the degree to which care is
available, acceptable, comprehensive,
continuous, and documented, as well
as on the extent to which adequate
therapy is based on an accurate
diagnosis and not on
symptomatology”.
Quality in Health Care
3.
“Quality of care is the degree to
which health services for
individuals and populations
increase the likelihood of desired
outcomes and are consistent with
current professional knowledge”.
Quality in Health Care
4.
“Total quality management is a
management process of
continuous improvement – a
process of continuously
striving to exceed customer
expectations.”
Quality in Health Care

it should be clear that it is
extremely difficult to arrive at
a consensus as to what
constitutes good quality care
because of the implied values
inherent in a definition.
Quality in Health Care

Medical care or health care is not
a unitary concept and its
multidimensionality partly explains
the existence of the many
definitions and the several
approaches to measure it.
TOTAL QUALITY MANAGEMENT
Dr. Nasser Ali Al-Jar Allah.
QUALITY IS..
Conformance to requirements
( Philip B. Crosby )
 The characteristics through which
the product and service meet the
expectations of the customer ( Dr.
armand V. Feigenbaum).

QUALITY IS..


Meeting or exceeding customer
expectations at a cost that
represents value to them.
Attention to internal customers needs
creates energy to provide valueadded service to the external
customer .
QUALITY IS..

1.
2.
quality comes in the following two
forms:
Effectiveness : doing the right thing;
producing features truly important to
the customer.
efficiency: doing things right;
executing tasks and processes right
the first time.
QUALITY IS..
EFFECTIVENESS
RIGHT
WRONG
RIGHT
Right thingsdone Right
RR
Wrong thingsdone Right
WR
WRONG
QUALITY
Right thingsdone Wrong
RW
Wrong thingsdone Wrong
WW
+
EFFICIENCY
-
+
-
QUALITY IS..

1.
2.
3.
4.
Quality = Doing the right things right
consistently to ensure;
The best possible clinical outcomes for
patients.
Satisfaction for all of our many
customers.
Retention of talented staff.
Sound financial performance.
QUALITY IS..
Customer’s
perspective;
delivery
safety
conformance
QUALITY
service
Responsibility
design
price
WHAT IS THE CURE?

5-s , 6- sigma, QA,
BPR, QCCs, ISO,
TPM,TQM, BE, all of
them are aimed to;
WHAT IS THE CURE?
Increasing Quality.
 Lowering Cost.
 Improving Value.
 Increasing Accessibility.

QUALITY MANAGEMENT
Teamwork
Customer
satisfaction
Employee
empowerment
Process & system improvement
Quality Assurance (QA) versus
Quality Management (QM)

1.
2.
3.
4.
QA;
Reactive
Punishing
mistakes
Meeting
thresholds
Use fear to work
harder.
5.
6.
7.
8.
Department
isolated
“quality” is
undefinable
Organization are
first
Customers are
external only
(patients).
Quality Assurance (QA) versus
Quality Management (QM)

1.
2.
3.
4.
QM;
Pro-active
(preventive)
Improving processes
Continual
improvement
Drive out fear.

5.
6.
7.
8.
QM;
Break down
barriers
“quality” is exact
Customer are first
Customers are
external and
internal (patients
and staff).
EIGHT STEPS TO QM
1.
2.
3.
4.
Who are our customers?
What do they need ?
What do we have to do to meet
their needs?
What do we measure
(indicators) to know how well we
are doing ?
EIGHT STEPS TO QM
5.
6.
7.
8.
Gather data /monitor
indicators.
Analyze data and report
results.
Identify opportunities for
improvement.
Take corrective action.
Models and Tools of QM
“ PDCA”= plan, do, check, act.
 Brainstorming.( problem
analysis)
 Flowcharts.- (process)
 Pareto Charts. (size of problem )

Models and Tools of QM
Trend Charts. ( trend of problem )
 Cause-and-Effect, or Fishbone,
Diagrams.
 Tree Diagrams. ( process, cause
and effect)
 JAR.
