Quality concepts by Memo Nesta

Prof. MOHAMED I. EL KALIOBY Prof. & Head Of Pediatrics Department Director of Center for Research and Development in Medical Education and Health Services (CRD),

Member of QAU Executive Council Faculty Of Medicine, Suez Canal University, Egypt

INTRODUCTION TO QUALITY CONCEPTS

Time Schedule of The Day 10.00 – 11.00: 11.00 – 11.30: 11.30 – 12.00: 12.00 – 12.15: 12.15 – 12.45: 12.45 – 1.30: 1.30 – 2.15: 2.15 – 3.00: 3.00 – 3.30: 3.30 – 4.00:

Introduction Task A (Small groups) Large group Discussion Comments Break Task B (Small groups) Large group Discussion Task C (Small groups) Large group Discussion Exercises & wrap out

ITEMS • • • • • • • • • •

QUALITY: Definition, Dimensions, Importance. HISTORICAL BACKGROUND. QUALITY CONTROL QUALITY ASSURANCE: Definition, Steps, Goals QUALITY IMPROVEMENT QUALITY MANAGEMENT TOTAL QUALITY MANAGEMENT HIERARCHIAL STRUCTURE Cost of Quality ISO SYSTEM

What do we mean by quality? • Quality = Good • The totality of features and characteristics of a product or service that bears on it’s ability to satisfy the stated or implied needs (ASQC) “Are we doing things right?” “Are we doing the right things?” The key twin questions in the application of quality procedures in any domain of activity.

What is Quality? • User-based: “In the eyes of the beholder” “quality means meeting or exceeding customer expectations” (Juran, 1951, Feigenbaum, 1962, Deming,1986)

• Manufacturing-based: “Right the first time or Zero defects ” (Crosby, 1979)

• Product-based: Precise measurement

Dimensions of Quality • • • • • •

Performance ‫األداء‬ Reliability ‫الصالحية‬ Durability )‫صمود المنتج (العمر االفتراضى‬ ‫خدمة مابعد البيع‬ Service after sale ‫شكل وجمال المنتج‬ Aesthetics ‫مزايا أو خصائص المنتج‬ Special features: convenience, high tech ‫األمان والسالمة‬ • Safety ‫سمعة المنتج‬ • Perceived Quality

Importance of Quality • • • • • •

Lower costs (less labor, rework, scrap) Motivated employees Market Share Reputation International competitiveness Revenues generation increased (ultimate goal)

HISTORICAL BACKGROUND Origin of Concepts and methods which are the basis of quality procedures were developed, Mainly in USA and Japan In industrial environments during and after the 2nd World War. The aim: *to make production processes more efficient by reducing faults and errors - one of the watchwords was â&#x20AC;&#x153;zero tolerance of errorâ&#x20AC;? and *to produce goods of consistently high, and standardised quality. In order to achieve this, a number of procedures and principles were developed.

HISTORICAL BACKGROUND 2

‫•الجودة‬ THE OLDEST TERM QUALITY ‫•ضبط الجودة‬ • QUALITY CONTROL • QUALITY ASSURANCE ‫•ضمان الجودة‬ • QUALITY IMPROVEMENT ‫•تحسين الجودة‬ • QUALITY MANAGEMENT ‫•إدارة الجودة‬ • TOTAL QUALITY MANAGEMENT ‫•إدارة الجودة الشاملة‬ CURRENTLY ENTERPRISES ARE RUSHING TO • SIX SIGMA (1980s) • DEMING AWARD (1951) • MALCOLM BALDRIDGE NATIONAL QUALITY AWARD (MBNQA) (1987)

QUALITY CONTROL The procedures used to check and assess the quality of the products or services.

It was stressed that correcting mistakes was expensive and time-consuming. Therefore the aim was to â&#x20AC;&#x153;get it right the first time, every timeâ&#x20AC;?.

QUALITY ASSURANCE The systematic procedures and planned steps taken by an institution to make sure that it provides products or services of a high quality.

Goals ď&#x192;ź Provide management with the data necessary to be informed about product quality ď&#x192;ź Make confidence and be sure that product quality is meeting its goals

QUALITY ASSURANCE 2

Plan: Establish objectives and processes required to deliver the desired results.

Do: Implement the process developed. Check: Monitor and evaluate the implemented process by testing the results against the predetermined objectives

PDCA, Deming Cycle, Shewhart cycle, Deming Wheel, or Plan-Do-Study-Act.

Act: Apply actions necessary for improvement if the results require changes.

QUALITY ASSURANCE 3

How to check? • Analysis • Auditing • Reporting

‫كيف تتتم االختبارات ؟‬ ‫• التحليل‬ ‫• المراجعة أو المراقبة‬ ‫• التقارير‬

Who will check? ‫من سيقوم باالختبارات ؟‬ There are two parts to a QA system: • internal quality assurance process • external quality assurance process

QUALITY IMPROVEMENT • Quality Improvement is a formal approach for: * analysis of performance and * systematic efforts to improve it. There are numerous models used. The commonly discussed include: • FADE (Focus – Analyze – Develop – Execute - Evaluate) • PDSA (PLAN – DO – STUDY – ACT) • Six Sigma • CQI: Continuous Quality Improvement • TQM: Total Quality Management -

QUALITY MANAGEMENT It is a method for ensuring that all the activities necessary to design, develop and implement a product or service

It can be considered to have 3 main components: 1) Quality control, 2) Quality assurance 3) Quality improvement. It is focused not only on product quality, but also the means to achieve it.

are effective and efficient with respect to the system and its performance.

QUALITY MANAGEMENT 2

A systematic set of operating procedures

which is: Company / Organisation wide, documented, implemented and maintained While ensuring the growth of business in a consistent manner

QUALITY MANAGEMENT 3

Flow Chart It is a tool that graphically represents * the steps of a process or * the steps that users have to take to use the service (user Flowchart).

QUALITY MANAGEMENT 4 Flow Chart 2

Who uses Flowchart? The team, the manager. Why use Flow Chart?

When to use Flow Chart? Flowchart helps you analyze When you want to *describe activities, *number of steps and *time required for each step, *identify problems, *identify the causes of *to detect bottlenecks, problems, *unnecessary steps, *detect "bottlenecks," *repetitions, and and *other obstacles. *define indicators.

QUALITY MANAGEMENT 5 Flow Chart 3

Different symbols are used in a Flowchart to indicate the different types of actions in the process: Circle: the beginning or end of the process Rectangle: a step in the process (activities) Diamond: the decision points 



QUALITY MANAGEMENT 6 Flow Chart 4

â&#x20AC;˘ How to create a Flowchart: 1) Observe for a few repetitions the process you will be charting. 2) Write down all the steps taken and decisions made in the process. 3) Mark the path of the Flowchart from the beginning to the end by connecting all the rectangles (activities)and diamonds (decision points). 4) Return to the beginning of the path and repeat Step 2 for any paths that branch off from the main path (at the decision points). 5) Record the last step at the bottom of the page, draw a circle around it, and connect the primary path and any branching paths to the last step. 6) Review for accuracy.

TOTAL QUALITY MANAGEMENT • THE LATEST APPROACH • IT IS THE PROCESS OF INDIVIDUAL & ORGANISATION DEVELOPMENT • THE PURPOSE OF WHICH IS TO INCREASE THE LEVEL OF SATISFACTION OF ALL THE STAKEHOLDERS

QM Vs QA Item

Quality Management

Quality Assurance

Prime Focus

Achieving results that satisfy the Demonstrating that the requirements for quality. requirements for quality have been (and can be) achieved.

Motivation

Stakeholders internal to the organization, especially the organizationâ&#x20AC;&#x2122;s management

Stakeholders, especially customers, external to the organization

Goal

To satisfy all stakeholders

To satisfy all customers.

intended result

Effective, efficient, and continually improving, overall quality-related performance.

Confidence in the organizationâ&#x20AC;&#x2122;s products.

Scope

covers all activities that affect covers activities that directly the total quality-related business affect quality-related results of the organization process and product results

HIERARCHIAL STRUCTURE

Costs of Quality Means to quantify the total cost of qualityrelated efforts and deficiencies.

by Armand V. Feigenbaum, A (1956)

Costs of Quality Prevention costs

Failure costs

• • • •

Internal failure

Quality planning Formal Technical Reviews Test equipment Training

Appraisal costs

• Rework • Repair • Failure mode analysis

External failure

• Complaint resolution • In-process and inter-process • Product return and replacement Inspection • Equipment calibration and • Help line support • Warranty work maintenance • Testing

ISO SYSTEM Various organizations have been set up to establish standards, (general or for a particular activity), and to validate that the standards are being kept. The International Standards Organization (ISO) has a series of norms (eg ISO 9000, ISO 9001-2000, ISO 14000, ISO 17025) which is applied to service industries, including a range of schools of different kinds.

ISO SYSTEM 2

The ISO certification checks that there are proper procedures for ensuring quality standards and these are consistently applied, but makes no judgment of the quality of the product or service itself. Eg In an educational context, it would check that there were procedures for observing and assessing the quality of the teaching, but it would not make an assessment of the work in the classroom.

ISO Vs TQM Item CUSTOMER FOCUS

ISO 9000

TQM

NOT NECESSARILY

DEFINITELY

TECHNICAL SYSTEM PROCEDURES

PHILOSPHY, CONCEPTS, TOOLS & TECHNIQUES

NOT NECESSARY

NECESSARY

LESS OR NO FOCUS

CQI &TQM ARE SYNONYM

CAN BE DEPATMENTALLY FOCUSED

ORGANIZATION WIDE

RESPONSIBILITY FOR QUALITY

QUALITY DEPARTMENT

EVERYONE

FUNCTION

PRESERVES THE STATUS

IMPROVES PROCESS & CULTURAL CHANGE

FOCUSING ON

EMPLOYEE INVOLVEMENT CQI

Six Sigma • Six Sigma is a business management strategy originally developed by Motorola (mid-1980s), that today enjoys widespread application in many sectors of industry. • A measure of quality that strives for near perfection. • Six Sigma seeks to identify and remove the causes of defects and errors in manufacturing and business processes • It uses a set of quality management methods, including statistical methods. • It creates a special infrastructure of people within the organization ("Black Belts" etc.) who are experts in these methods.

Six Sigma 2

â&#x20AC;˘ Each Six Sigma project carried out within an organization follows a defined sequence of steps and has quantified financial targets (cost reduction or profit increase).

â&#x20AC;˘ Originally, Six Sigma was defined as: a metric for measuring defects and improving quality; and a methodology to reduce defect levels below 3.4 Defects Per (one) Million Opportunities (DPMO). (driving towards six standard deviations between the mean and the nearest specification limit) in any process -- from manufacturing to transactional and from product to service.

Six Sigma 3

â&#x20AC;˘ Models: DMAIC (define, measure, analyze, improve, control): is an improvement system for existing processes falling below specification and looking for incremental improvement. DMADV (define, measure, analyze, design, verify) is an improvement system used to develop new processor products at Six Sigma quality levels.

DEMING AWARD Japanâ&#x20AC;&#x2122;s national quality award for industry. It was established in 1951 by the Japanese Union of Scientists and engineers (JUSE). W. Edwards Deming. He brought statistical quality control methodology to Japan after World War II

MBNQA (MALCOLM BALDRIDGE NATIONAL QUALITY AWARD) The Baldrige Award was established in 1987 to promote quality awareness, understand the requirements for quality excellence, and share information about successful quality strategies and benefits. Three eligibility categories: manufacturing, services, and small firms.

Only five companies who received this prize. There are no service companies

Task A (30 min) • During periodic evaluation in a health care center , there was a decrease in the flow rate of users. • The quality improvement team reviews the data to identify the problem. • You are trying to fully describe the problem to understand its causes and roots.

A) How to analyze this problem?

‫• فى أثناء التقييم الدورى‬ ‫فى أحد مراكز الرعاية‬ ‫الصحية تبين انخفاض‬ .‫معدل تردد األهالى‬ ‫• عكف فريق تحسين‬ ‫الجودة على مراجعة‬ ‫لتحديد‬ ‫المعلومات‬ .‫المشكلة‬ ‫• بصفتك أحد أفراد الفريق‬ ‫فإنك تحاول توصيف‬ ‫المشكلة لفهم أسبابها‬ .‫وجذورها‬ ‫كيف تحلل هذه المشكلة؟‬

Root Cause Analysis Tools Fishbone Diagram The 4 P's: place, procedure, people, policies ‫المكان‬ ‫اإلجراءات‬ )‫البشر (الناس‬ ‫السياسات‬

• • • •

The Five Whys Method

Users Surveys Steps for Developing a Questionnaire

1. Determine the purpose & objectives. ‫الغرض واألهداف‬ 2. Develop questionnaire specifications. ‫الخصائص‬ 3. Review existing questionnaires. ‫مراجعة المتوافر‬ 4. Develop new questionnaire items. ‫إضافة بنود جديدة‬ 5. Develop directions for administration and examples of how to complete questions. ‫إرشادات وأمثلة عن كيفية االستيفاء‬ 6. Establish procedures for scoring the questionnaire. ‫كيفية الحساب‬ 7. Conduct a preliminary review of the questionnaire with colleagues or coalition members. ‫مراجعة أولية‬ 8. Revise questionnaire based on review. ‫إعادة النظر‬ 9. Pilot test the questionnaire with twenty to fifty subjects. ‫تجريب‬ 10.Check questionnaire for reliability and validity. ‫االختبار‬ 11.Provide questionnaire specifications and present to a panel of experts for review. ‫مراجعة نهائية بواسطة خبراء‬ 12.Revise the questionnaire based on comments from the panel of experts. ‫إعادة النظر من جديد‬

Developing questionnaires takes a great deal of time and expertise.

Using questionnaires that have already been developed by experts may be a more efficient option.

Task B (45 min) You decided to develop a questionnaire to the users attending the health care center to find out the root causes of problems that may face them. Develop a preliminary questionnaire to be reviewed by your colleagues.

‫قررت تصميم استمارة‬ ‫لألهالى‬ ‫استبيان‬ ‫المترددين على مركز‬ ‫الرعاية الصحية لتحديد‬ ‫الجذرية‬ ‫األسباب‬ ‫للمشاكل التى تواجههم‬ ‫وتؤدى إلى عزوفهم عن‬ .‫الحضور‬ ‫صمم استمارة استبيان‬ ‫مبدئية لعرضها على‬ ‫زمالئك‬

Task C (45 min) • There are many issues that affect the users, yet through the user survey, one major problem is revealed. • Users wait too long when they come to the health center for services. ‫االنتظار لمدة طويلة عند حضورهم للمركز الصحى‬ • Since they feel that they waste time by waiting too long, most of them decide to use the health center services less regularly, or not at all.

Task C (cont1)

â&#x20AC;˘ You and your team decide to use a flowchart to analyze the process the users go through in using the health center's services, and to visualize when the waiting time occurs. â&#x20AC;˘ You will observe the user from his or her arrival in the center to his or her departure , observing all the steps taken by the users in the health center. â&#x20AC;˘ The team draws the process that users follow from their arrival at the health center to their departure by putting each activity in a rectangle and each decision point in a diamond, and connecting all these rectangles and diamonds in order.

Task C (cont2)

â&#x20AC;˘ The flow chart allows the team to replicate the steps each patient goes through. â&#x20AC;˘ Try to do the flowchart.

REFERENCES • http://erc.msh.org/quality/pstools/psflcht.cfm • Deming, E, W. (1986): Out of the Crisis. Cambridge, Mass.: Massachusetts Institute of Technology, Center for Advanced Engineering Study. ISBN 0911379-01-0. • Frank Heyworth: Concepts of Quality, http://www.ecml.at/html/quality/english/framework/FH1_concepts%20of %20quality_e.htm • www.pu.edu.pk/departments/lectures/BASICCONCEPTSOFQUALITY%5B1 %5D.ppt • ASQC: American Society for Quality Control • Patient safety, quality improvement, Department of community & Family Medicine, Duke Univ Med Center, http://patientsafetyed.duhs.duke.edu/module_a/module_overview.html

Prof. M. I. El Kalioby kalioby@kalioby.com