07.7 Qm Focus Summry

8/2/2019 07.7 Qm Focus Summry

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The FOCUS PDCA Methodology

Majdah Shugdar Page 1 of 11

Collected by: Majdah Shugdar

Executive Director , Admin Affair

Central Board for health care Institution, CBAHI


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Continuous Quality Improvement

Continuous quality improvement (CQI) is aconcept that came out of the business industry.

Rather than creating a culture of blame if thingsdo not go well, the focus is on a team approach to

improvement that rewards the group when thingsget better.

CQI has been adapted for health care in several

ways. One acronym for this is FOCUS-PDCAwork:

FOCUS - PDCA is an extension of the Plan, Do,Check, Act (PDCA) cycle sometimes called theDeming or Shewhart cycle.

FOCUS-PDCA: FOCUS-PDCA it is a simple, logical,

and systematic approach to accomplish

incremental improvement of an existing process, or

to redesign an existing process or design an

essentially new process or in problem solving.

The guidelines for using FOCUS-PDCA are:

If a problem analysis is needed,

If a task is either new or unique. A routine

task normally doesn't necessitate a PDCA

unless a major new factor is introduced,

First, FOCUS on a particular issue.

Find a process to improve

Organize to improve a process

Clarify what is known

Understand variation

Select a process improvement

Then, move through a process improvement plan,PDCA

Plan: create a timeline of resources, activities,training and target dates. Develop a data

collection plan, the tools for measuringoutcomes, and thresholds for determining

when targets have been met.

Do: implement interventions and collect data.

Check: analyze results of data and evaluatereasons for variation.

Act: act on what is learned and determinenext steps. If the intervention is successful,work to make it part of standard operating

procedure. If it is not successful, analyzesources of failure, design new solutions andrepeat the PDCA cycle.

The PI p ro j ec t shou ld beg in w i t h FOCUS i f a

p rocess a lready ex is t s . I f a p r ocess does no t

ex is t , beg in w i t h PDCA.

Step 1."F" for Find a problem, process

improvement opportunity. "If no problem is

recognized, there is no recognition of the need for

improvement." Imai

It is important to review and determined a priority

for your organization. Think through the following

questions: Was the problem identified through a

needs assessment or through a prioritization tool?,

What is your baseline data that indicates an

opportunity? , Who are the internal and external

customers? Write a one or two sentence overview

of the improvements that are needed.

Step 2. "O" for Organize a team that knows

about the problem or process in review.'Teams provide possibilities for empowerment that

are not available to individual employees."

1. Do you need to organize a team? Address

why a team is being formed. In order to

assemble the correct team to improve the

process or problem ask the following


The FOCUS PDCA Methodology


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questions: Who would be helpful? Who

needs to be involved? Who has knowledge

on the process or problem? Who would

benefit from being involved as job

enrichment or a learning experience? Who

would benefit from the opportunity to beinvolved in problem solving, planning or

process monitoring? Who is creative? Who

has organizational skills?.

2. Tell the selected team the purpose of the

project. Encourage all team members to be

logical and creative. Stress the importance

of teamwork, and that every member is

important. Empower the team to make a

contribution. Teams often struggle to

understand how the tasks, which are part

of their jobs, fall into a sequence of steps

(process) or how intricately departments

are related.

3. Once the team members are organized,

their roles and responsibilities need to be

identified throughout the duration of the

project. Plan and decide who is going to be

the leader and organizer, as well as who is

going to write and document the progress

to communicate results.

Step 3. "C" for Clarify current know ledge of

the process/ problem. "A problem well stated is a

problem half solved.

1. Analyze the process to distinguish between

expected and actual performance. Study

the current situation without trying to

develop long term solutions. To have a

clear statement of the situation, you must

first do background work. Look carefully at

the situation to detect and interpret

evidence. Talk to people involved, review

records about the process and watch theprocess first-hand. Recognize the problem.

Define and explain the current situation or

process in question.

2. Some of the questions that are asked in

this step are: What is your understanding

of how the process should flow? What is

the background of the problem? Who is

involved in the problem? How does the

problem impact quality? What is the cost of

the problem or process break down?

Identify the most significant problem.

Define the problem. Once this is

determined ask yourself the following:What is deficient? What is not working?

What is the perception of quality? Have

there been customer complaints, incidents?

How big is the problem? Where is the

problem? Is the problem chronic or

sporadic?

3. Some of the PI tools and techniques

developed to help define a process and

problem are flowcharting and

brainstorming.

4. Immediate and necessary action should not

be ignored. Identify if there are any short-

term quick and easy improvements.

5. If you discovered the process is not being

followed than re-educate staff on the

correct standard operating procedures and

standardize the best current method.

Step 4. "U" for Understand causes of process

variation and uncover possible causes of

problem. Investigate and eliminate unusual

occurrences. "I have no particular talent, I am

merely inquisitive." Albert Einstein

1. Determining the possible underlying causes

of problems and process variation requires

some research, investigating, and

analyzing. Do not jump towards a solution

in this step.


Sometimes what appears to be the problem

actually turns out to be related to other issues.

Some of the questions used in this step to

identify reasons and process variables are asfollows: What are some of the most likely

causes of the problem and process variation?

What are the probable reasons for deficiencies?

What is the impact on customers? There are

many verbal tools and techniques, which can

be utilized to help organize the thoughts of a

group, in order to analyze problems and


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determine causes. Some of these are:

flowcharting, storyboarding, force field

analysis, brainstorming, and Ishikawa (cause

and effect diagramming or the fishbone

diagram).

2. The Ishikawa or cause-effect diagram is

used as a first step before data gathering

to find out what is really going on with a

problem. The purpose of the diagram is to

determine causes of a problem in order to

solve the problem. The problem analysis

involves diagramming and is also known as

a fishbone diagram because of the

pictorial. The effect or problem is first

drawn as the "head" of the fish on the right

side of the paper. A horizontal line is drawn

from the head down the entire length of

the paper. Branches are drawn off the line

on angles. Each line represents a process

related to the problem.

3. The process analysis involves looking at

either standard parts of a process or the

specific steps in a flowcharted process to

determine what you do and do not know

about the process or problem. The

M.M.M.M.E. acronym is a way to remember

the standard parts of a process by looking

at m en(personnel, staffing and training),m a t e r i a l s or items used, the

m e t h o d s or operating procedures,

mach ines or equipment such as

computer systems, and the

e n v i r o n m e n t such as sound and

workload. Look at each part of the process

and determine the causes of the problem

by brainstorming and asking why a

problem occurred. Each cause of a problem

is then diagrammed off the line. You keep

asking why until you've reached enoughdetail. The process of asking why is known

as the Five Why's. The causes can then be

analyzed and sorted.

4. Measure process variables if necessary and

evaluate the data. Measurement allows one

to quantify problems and confirm the

causes of the problems. Examples of data

based PI tools used in this step are check-

sheets, Pareto diagrams, scatter diagrams

and run charts. Pareto analysis helps to

quantify the causes of problems. Look at

the available data and stay objective in

nature as you review the data.5. Examine your processes for variation or

unusual occurrences. Investigate the

process and problem by asking questions

to find out what happened differently.

Were new personnel involved in the

process? Is the problem affected by

employee fatigue related to on-call

schedule? You need to continue to

standardize the processes as much as

possible by making corrections to unusual

causes of problems.

6. If the problem requires intensive root

cause analysis or measuring source

variation then use the Process

Improvement methodology and not the

FOCUS-PDCA. Sentinel Events require

process improvement analysis. Special vs.

common cause variation is illustrated with

the use of control charts and is used in the

Process Improvement methodology.

Step 5. "S" for Selects the performance

improvement by prioritizing/ select an

improvement strategy/ state the narrative

goals/ start the improvement cycle. "Quality is

never an accident, it is always the result of high

intention, sincere effort, intelligent direction, and

skillful execution. It represents the wise choice of

many alternatives." Willa A. Foster

1. Define your overall goal, process, or

outcome improvement. Be specific as to

what your project will focus on in order to

eliminate the problem or process variation.Define what change is to be made.


2. Questions to ask in this step as you aim for

long-term solutions are as follows: Will the

action eliminate the problem? Will process

variation be decreased? Identify the

potential action, solution, alternative or

option that will improve the process then


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assess the following: Is the solution risky?

What are we trying to accomplish? What

changes can we make that will result in

improvement? How will we know that a

change will result in improvement?

3. Identify the opportunities for improvementby establishing priorities. The goal of this

step is to consider many alternative

actions, in the end choosing the best

solution or first steps towards the solution.

Continue to be creative and innovative

solutions should be based on potential in

order to prevent recurrences of the

problem. Solutions address the cause of

the problem, and are cost-effective and

capable of being implemented within a

reasonable amount of time. Examples of PI

tools and techniques used for prioritization

are: prioritization grids, selection grids and

the Pareto Analysis, 80% of the problems

can be corrected by changing 20% of the

systems. Pareto analysis is the process of

ranking opportunities to determine which

of many potential opportunities should be

pursued first.

"P" for Plan includes steps 6-9. "Planning is

future-oriented, and the future will arrive whether

the organization is ready or not." Wynn and

Guditus

Step 6. Plan the action for performance

improvement/process design/project

planning. "People seldom hit what they do not aim

at." Henry David Thoreau

If you do not have a process in place, begin with

the Plan stage. Plan the implementation and

evaluation of the improvement. The most important

part of problem solving is planning the action youare going to take. The action should be directed at

eliminating the cause of the problem.

Are you re-designing an existing process or are

you designing a new process? Your plan may

require contingency planning which helps design

back ups. Your plan may require critical paths

outlining dependencies between departments. You

may need to strategically plan for the future by

determining what needs to be in place to get where

you want to be.

To make improvements in a process you mustknow all the aspects of the process. Take the

process apart into sequential series. Determine the

basic flow of proposed activities by flowcharting the

basic steps of the process. Design processes in

order to have a smooth flow of interdependent

activities. A flowchart is a graphical tool that shows

process information. Flowcharts are similar to

maps. Draw a flowchart, value added flowchart,

PERT (Planning Evaluation Review Technique) chart

or Gantt chart of the process or interrelated

processes. You can draft a flowchart by hand or use

software programs such as Microsoft Word,

Microsoft Project or Visio.

Step 7. Design the measurement plan. "You

can't manage what you can't measure. " A. Banker.

Never assume the action will result in

improvement-measure-measure-measure. A

measurement plan is required to establish the need

for improvement, as well as to assess

improvement. Measurement provides the data

needed to assess how well a process is working.

Data is the voice of a process. The measurement

plan is a plan to measure what you plan to do.

Measurements provide objective data to separate

opinion from fact. This is essential for valid problem

solving. Planning the measurement plan means

planning how an improvement action will be tested

and how data will be collected. The measurement

data are used to regulate, modify, monitor, accept

or reject a process being studied. An understanding

of data is necessary before you can develop a

measurement plan.

Information on data in general:


Measurement can be obtained either qualitatively

or quantitatively. Qualitative measurement is

measuring with words. Words are grouped into

categories (e.g. like or dislike, agree or disagree,


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satisfied or dissatisfied.) Quantitative measurement

is measuring solely with numbers.

Some of the reasons to collect data of your project

are:

To create a baseline if one does not exist

To monitor the process over time

To see the effect of a change in the process

To determine the impact of the change or

what effect the action has

To evaluate the effectiveness of your

problem resolution and determine whether

change led to the expected improvement

To determine whether or not to continue

working on the process

To provide a common reference

To provide feedback on the performance of

a system in the form of data

To provide information for decision making

To provide follow-up data indicating

measurable improvement.

There are different types, kinds, definitions and

categories of data:

Types of data are:

1. perception of care (opinion) data,

2. observable (seeing what there is and

recording it) data,

3. strategic outcome measures, lag indicators

or results data (after everything has

happened), or

4. performance driver measures, lead

indicators, or process measures (data that

are early indicators so that the process canbe adjusted before undesirable results

occur).

Kinds of data are:

5. financial,

6. operational,

7. clinical and,

8. satisfaction.

Examples of definitions of data are:

9. patient specific,10. aggregate data,

11. knowledge based.

Categories of data: Decide how you want the

data categorized in order to be analyzed. Some

medication system examples are:

12. Analyze by medication use processes:

selection & procurement, ordering &

prescribing, dispensing, administration or

monitoring

13. Analyze by sub classification: dosage form,

duration, rate, time, dose, missed dose,

route of administration, drug, monitoring

error, strength/concentration, drug

deterioration, patient, technique.

14. Look at what type of employee caused the

error: Nurse, pharmacist, pharmacy tech,

delivery tech

15. Analyze if error was equipment or supply

related: pump, tubing, syringe, bag

16. Volume: Look of how many orders are

processed each week. How many orders

are processed on-call each week?

17. Population size: All orders over time, using

a sample of 100 orders in a week for

example. Using a sample of 100

medication orders each week, how many

have 1 or more errors?

18. Out of all the orders (in a day, week) how

many errors are caught before shipping?

How to collect data: Data can be collected

many different ways. Perception of care data iscollected on surveys and can be done in person, by

mail, over the phone or in focus groups. Check

sheets are used to record sample observations and

detect patterns.


How to display data: Data can be visually

displayed in many different and creative ways to


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help analyze and turn the quantitative data into

information. Pareto charts are horizontal graphs,

which run from high (left) to low (right). The

vertical bars illustrate the individual category being

compared. Run charts graph data over time to

determine trends. Concentration diagrams displaydata within a picture.

Step 8. Estimate cost/ completion date. "You

can't build a house without hammer and nails."

Hosotani

Estimate the cost of the project, including cost of

actions and cost of data collection. Resources are

the supplies, equipment, personnel, etc. required to

accomplish the objective.

Determine timelines, milestones and the target

completion date to having the objective

accomplished.

Step 9. Education "QC begins and ends with

education." Ishikawa

Some general and specific education on

performance improvement may be necessary when

explaining to the employees how organizations

work in processes to make improvements in daily

work. Improve learning to advance improvement.

Before moving from the plan stage to the do stage,

train your employees on purpose of project,

process changes and data collection. Dont surprise

people with change. Explain the change and its'

effects. Who will need to change the way they do

their jobs? What are the sampling instructions?

What training is needed?

"D" for Do.

Do is explained on step 10 and 11. "Employeeswho feel capable of solving problems, do."

Townsend and Gehardt

Do is when the action you planned is carried out.

The action could be a trial situation where you

perform the test by implementing the action on a

small scale or it may be an actual implementation.

There should be a historical summary of all the

action steps taken towards accomplishing the

objective.

Step 10. Implement the improvement "A useful

motto during the start-up phase is, think big-startsmall." Ernst & Young

Select and implement a solution. Do you need to

test a pilot (trial basis) first? It is best to carry out

a small-scale change or project before incurring the

cost of widespread implementation. Pilot projects

are forgiving. By doing a pilot first, it gives

unforeseen obstacles a chance to surface before the

real implementation. Do not carry out a full

implementation after a pilot until a successful trial

has been approved in the Check stage. If you do

not pilot, then implement the action plan.

Set a date of implementation of performance

improvement. Describe what was used to

implement the plan. Carry out the improvement as

planned.

Step 11. Implement data collection "Well begun

is half done." Horace

Implement the data collection. You may want to

pilot the data collection, instruments and

procedures first to make sure that everything is in

place.

Establish baseline data if there is no baseline data.

Initiate the data collection in full or pilot the data

collection process by testing on trial basis. Do Data

Collection. Collect data to monitor the performance.

Clear criteria need to be established. The use of

common checklist or data collection forms can help

to ensure consistency and reliability in data

collection. Plan how you are going to present thedata in a clear and understandable form.

"C for Check "Whatever is worth doing is worth

evaluating." Wynn and Guditus


Check/ Study's steps are between 12-14.


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The Check/Study stage is the analysis. Here we

judge how well we have accomplished the plan

based on information and determine the next steps.

This step is often omitted, which leaves the

effectiveness of a plan in question.

Step 12. Results of action " An accepted leader

has only to be sure of what is best to do, or at least

to have made up his mind about it." Winston S.

Churchill

Check involves evaluating and analyzing the effect

of the action being tested. What did you learn? Is

the solution you've chosen working? Do you need

to take corrective action? Do you have the right

staff in place? Do any changes need to be made?

What are the pros and cons of the plan? Was there

any unplanned information you collected? Was your

prediction correct? Do you need to go back and

implement another portion of the plan? Results

should flow from management to staff for more

improvement strategy input and back to

management. At this point there is a choice. You

can abandon the idea, repeat to modify the idea, or

go on to the "act" stage to standardize the process

if the data validates the solution works.

Step 13. Results of data :

Data are simply facts; information is the actual

answer to a question. Information is based on data,

but simply having data will not provide information.

Transforming data into information is the key to

this step.

Determine intervals to review data (e.g. daily,

weekly, and monthly.) Check for errors. Was there

any unplanned data you collected? Tabulate your

data. Who is going to review? Looking at your data

requires some evaluation and analysis. Comparebefore and after data. Check your data results vs.

target goals. Check your progress vs. plan. Assess

the effect of the action. Analyze and review results.

Determine if the findings meet acceptable limits.

Determine if findings are moving in the right

direction. Are there general trends towards

improvement? Check data for process improvement

and check data for customer outcomes. Look at all

the related data. Monitor the progress and

effectiveness of the change according to your plan.

Gather data from key points. Analyze data

collection results after implementing solution to

evaluate for process improvement and for customeroutcomes. Was your prediction correct? Use the

data in your decision making whether or not to

adopt action. How can you be more cost-effective?

Evaluate the solution and the follow up. Check the

data collection results after the implementation of

your plan in order to evaluate improvement. The

solutions you have developed may have

accomplished your intentions. Sometimes,

however, they don't or they may only partially

solve the problem. They may even cause other

problems or prove to be too expensive. You need to

check. Now, you must check the solutions to verify

their effectiveness in solving the problem, to see if

they cause other problems, and to see if they are

cost-effective. You can document changes to the

process by comparing the data before you began

the project with data developed at this stage.

Analyze data to evaluate the improvement.

Measure and assess the effect of the action.

Monitor the progress and effectiveness of the

change according to your plan. Run charts, scatter

diagrams, histograms, check sheets, Pareto charts

(your hope is that the large category your team

worked on is now only a small bar on the Pareto

diagram, or even gone completely.)

Repeat some of the steps if data does not meet

target. Continue to evaluate the data or

performance improvement evidence to use as

information in your decision making. Once data

validates the solution will work you can move to the

Act stage.

Turning data into information by using a bar

graph is illustrated in the Appendix as

Example 4.


Step 14 Repeat "It is common sense to take a

method and try it. If it fails, admit it frankly and try


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another. But above all, try something. " Franklin D.

Roosevelt

Have you accomplished your original goal? After

checking the implementation of the plan, you may

decide that the "do" stage has not accomplished allyou intended it to. Instead of going to "act" you

must make an adjustment. Describe how the target

wasn't met. You can abandon it, or make further

revisions. Does the change idea have potential, or

do you need to abandon the idea and start again

with a new idea? Repeat the cycle. If the solution is

not correcting the problem, then the process should

begin again to determine a better solution. This

means we review our plan and its implementation

and search for ways to improve. If results are not

where you want them you must go back to make

an adjustment. You must need to modify or adjust

your solution. Now is the time to stand back from

the problem, rethink it, and possibly develop new

plans. Ask yourself: What has our team tried? What

have you accomplished so far? In what ways does

our plan fall short? And most important, what do

you and the team plan to do about it? Go back to

your original analysis and decide if there were some

other possible causes that may be causes. You may

need to go back to any one of the steps as you

write your adjustment plan.

Often times you are not going to try to make all

your changes at once, because then you could not

measure the effectiveness. The first variable may

be successful, and now you want to try another

process variable working towards achieving the

original goal.

Continue to improve your measurement plan too.

Repeat the Plan and Do stages until you've met

your defined measurement objective. Once the datavalidates the solution will work you can move to the

Act stage.

"A" for Act

Act is explained from 15 through 20. "Until you

implement a decision, it is not really a decision at

all." Edward C. Schleh

ACT: Act on the information. Adopt the change. In

standardizing, you do what is required to keep theprocess going. For example, you may provide

employee training on a new process for continuity.

Act means fully implementing the action or

executing the solution by standardizing the

process. Once improvement has occurred, you

must immediately establish controls in order to

maintain improved performance. Otherwise, you

probably will not be able to keep the gains made.

Controls are like the "check" the "act" stages in

PDCA, because we make deliberate changes. You

act based on the results of our check. You modify

or plan accordingly, and you do or perform your

service in an improved manner.

Use your findings. Identify training. Identify

improvement needs. Compare results. Guide

budgets and resource allocation.

Step 15 Implement effective

actions/ solutions/ adopt change/if pilot

implement to full "I like the dream of the future

better than the history of the past." Thomas

Jefferson

Problems are solved only when recurrences do not

happen. If a pilot project was successful then

implement it on a full scale. The organization's

action plan for improvement is pilot tested and

implemented, if successful and objectives have

been achieved. Process revisions should be

finalized. Education is necessary. Determine a

completion date after goals have been met.Implement effective actions. Identify owner.

Determine if there are any processes that can be

eliminated. If revision is needed, then go back to

the necessary stage to revise.


If no further improvement is feasible, then

complete the project.


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Step 16 Follow up/ next steps/ refine change

"TQM programs provide people with the "freedom

to fail" which enables them to learn from mistakes

and accept the responsibility for their results and

for preventing repetition of errors: they do not

negatively sanction people and they remove fearfrom the workplace." Allan Sayle

How can the change be refined or revised? What

can be done to error-proof the process. Repeat the

cycle and learn from the results to improve the

process. Reinforce the progress. Make

improvements when needed. Do any changes need

to be made to the solution? Do any changes need

to be made in the measurement system? How can

the change and measurement system be refined.

What steps will be taken next?

Your first improvement action could have been

successful and now you can try another action. You

may try something new or add another measure to

continue to make improvements and reduce

variation. After the process has met performance

goals, the final step is to develop and put in place

new standards so that the problem stays solved.

Standardize the processes and systems to ensure

you will maintain and sustain improvements

The advanced Process Improvement methodology

monitors improvement using the six-sigma

approach and performance improvement isn't

achieved until minimal variation has been obtained.

Step 17 Lessons learned/ cost savings "Total

Quality Management (TQM) is the set of

management processes and systems that create

delighted customers through empowered

employees, leading to higher revenue and lower

cost." Juran Institute, Inc.

What lessons were learned? Learn from results.

Itemize things you wished you knew before you

started the project for example.

Step 18 Documentation/ communication

"Nothing has really happened until it has been

recorded." Virginia Woolf

It is not enough to find the solution. Deciding how

and to whom these lessons can be communicated

are important steps of a project. You can share

information many different ways. Information canbe shared either in writing or verbally.

Documentation is a channel of communication. The

paperwork produced is one of the most significant

channels of communication. The forms of

documentation are Minutes, action plans,

worksheets, data collection forms, summary

reports and project files. Written material can be

disseminated throughout an organization in many

ways such as being sent electronically or posted on

site or on an organization's Intranet site for a

centralized form of communication. Verbal

presentations are a very helpful venue to share

information as well. Verbal presentations can be

done in person at staff meetings or seminars, or

over the phone via a teleconference.


You need to share information both internally and

externally. Communication on all levels is

important. Do you need to make recommendations

to someone? Was a change made that needs to be

publicized? The method chosen to publicize the

solution depends on who is the target audience. Do

you need to report the findings to someone? Who

might be interested in learning what was learned?

Has a training plan been developed to train

personnel on new methods? By sharing information

in writing you not only provide evidence of your

efforts by sharing your progress, but also to open

your efforts for feedback during the process. Within

the organization it is important to share information

with all the employees by posting progress results

during the project. At completion, you can help

others learn by telling people how you achieved

your goal. You can share what actions wereimplemented, how you evaluated the effectiveness

of the action, how much did the solution cost, and

how effective your project turned out to be. What

lessons were learned? What are your follow-up

plans? Your team has the opportunity to express

any observations, conclusions or recommendations

that were gained from the problem-solving activity.


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What processes or steps in the PI project might be

improved further? What did you learn about

working as a team or about problem solving?

Documentation serves as both historic record

keeping and as resource material for others.

Information should also be shared externally to

enhance your public image. Marketing can promote

your Programs to Referral Sources and customers.

Marketing will have "Bragging Rights" for your

accomplishments.

Project is completed. Celebrate your success!

Step 19 Sustain performance improvement

"We just couldn't leave well enough alone." Toyota

Motor sales slogan

If your team is satisfied that your solutions have

solved the problem, you must show what has been

done to keep the solutions in place so that the

problem never reoccurs or occurs minimally with

little variation. To keep your staff focused and to

avoid a lapse into old routines and methods,

controls must be put in place to remind people of

the new method. Decide how you want to monitor,

review and re-evaluate periodically. Training may

be necessary to maintain gains. Performance

measures are used to determine if the

improvement is sustained. Continue performance

measurement to determine if improvement is

sustained over time.

Step 20 The PDCA cycle can be repeated again

and again; attempting to refine the

improvement.

Review over time. The PDCA cycle is cyclic not

linear. Even when improvements have been put in

place and effective improvements have beenstandardized, process management should not end.

Variables, such as new technology, change over

time. Accordingly, the improvements should be

reviewed periodically.

Bibliography

Accreditation Commission for Health Care, Inc. (2002)

Home Infusion Accreditation Manual

Allen, Roger E., and Stephen D. Allen (1995) Winnie-

the-Pooh on Problem Solving Penguin Books New York,NY 10014 (out of print)

Brown, Janet A. RN, CPHQ (1986-2001) TheHealthcare Quality Handbook: A Professional Resourceand Study Guide 2001 Sixteenth Annual Edition

Carey, Raymond, G. (2002) Measuring QualityImprovement in Healthcare: A Guide to Managing withControl Charts De Paul University Quality Institute

Dusenbury, Diane, and Steven W. Collins, ProcessManagement: A Method for Achieving DesirableHealthcare Results Journal for Healthcare Quality Vol.

24, No. 4 July/August 2002

Gomes, Helio (1966) Quality Quotes ASQ QualityPress, Milwaukee, WI

Joint Commission Resources (2001) 2001-2002Comprehensive Accreditation Manual for Home CareJoint Commission on Accreditation of HealthcareOrganizations

Joint Commission on Accreditation of HealthcareOrganizations (1994) Framework for ImprovingPerformance

Joint Commission on Accreditation of HealthcareOrganizations (1995) Leadership Skills for PerformanceImprovement: Planning for Quality

Joint Commission on Accreditation of HealthcareOrganizations (1988) Sentinel Events: EvaluatingCause and Planning Improvement

Joint Commission on Accreditation of HealthcareOrganizations (1996) Using Performance MeasurementTools in Home Care and Hospice Organizations

Joint Commission on Accreditation of HealthcareOrganizations (1999) Using Performance Measurementto Improve Outcomes in Home Care and HospiceSettings


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07.7 Qm Focus Summry