QUALITY DEFINITION Dr. Nasser Ali Al-Jar Allah. Quality Definition “ Quality is often used to signify ‘ excellence ’ of a product or service ”. “ meeting

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

introduced four absolutes of quality, these are :

A. the quality definition is ‘conformance to requirements’

B. the quality system is ‘preventive C. the performance standard is ‘zero defects’

D. the measurement to be made is ‘the price of

non-conformance’

Crosby

Crosby offers fourteen steps to management improvement:

1. Make it clear that management is committed to quality.

2. Form quality improvement teams with representatives from each department.

3. Determine where correct and potential quality problems lie.

Crosby

4. Evaluate the cost of quality and explain its use as a management tool.

5. Raise quality awareness and the personal concern of all employees.

6. Take actions to correct problems identified through the previous steps.

7. Establish a committee for the zero defects

program.

Crosby

8. Train supervisors to actively carry out their part of the quality improvement program.

9. Hold a ‘zero defects day’ to let all employees realize that there has been a change.

10. Encourage individuals to establish improvement goals for themselves and their groups.

11. Encourage employees to communicate to management the obstacles they face in attaining their improvement goals.

Crosby

12. Recognize and appreciate those who participate.

13. Establish quality councils to communicate on a regular basis.

14. Do it all over again to emphasize that the quality improvement program never ends.

Deming

offers fourteen points for the management of quality which are the following:

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

Deming

2. Adopt the new philosophy. We can no longer live with commonly accepted levels of delays, mistakes, and defective workmanship.

3. Cease dependence on mass inspection. Require, instead, statistical evidence that quality is built in.

4. End the practice of awarding business on the basis of price tag.

Deming

5. Find problems. It is management’s job to work continually on the system.

6. Institute modern methods of training on the job.

Deming

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.

Deming

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.

Deming

12. Remove barriers that stand between the hourly worker and his right to pride of workmanship.

13. Institute a vigorous program of education and retraining.

14. Create a structure in top management that will push every day on the above thirteen points

Juran offers ten steps to quality improvement

that are the following: 1. Build awareness of the need and

opportunity for improvement.2. Set goals for improvement.

Juran

3. Organize to reach the goals (establish a quality council, identify problems, select projects, appoint teams, designate facilitators).

4. Provide training.5. Carry out projects to solve

problems.

Juran

6. Report progress.7. Give recognition.8. Communicate results.9. Keep score.10. 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.


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."


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.


These three standards, which define a minimum framework of requirements for the development and implementation of a quality system.


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.


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.


In late 2000, ISO 9000 re-design of a new set of four main headings :

1. Management responsibility.2. Resource management.3. Process management.4. Measurement and analysis

improvement.

What are the motives that make us care about

quality?

Q.Why have several definitions ?


quality?

.Quality is a multidimensional and multifaceted concept.


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.


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.


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.


The Code of Hammurabi also contains the earliest known listing of charges for service, thereby incorporating the quality and cost of medical care.


The quality assurance activities began with the Joint Commission on Accreditation of Hospitals in the 1960s and 1970s.

Patient Rights and Improving Organization Management of Information

Organizational Ethics Performance

Patient Rights Plan Information Management PlanningOrganizatiol Ethics Design Patient-Specific Data and Information

Measure Aggregate Data and InformationAssessment of Patients Assess Knowledge-Based InformationInitial Assessment Improve Comparative Data and InformationPathology and Clinical LaboratoryServices-Waived Tasking Leadership Surveillance, Prevention

Reassessment Planning and Control of Infection

Care Decisions Directing Departments Surveillance, PreventionStructure Supporting the Integrating and Coordinating and Control of InfectionAssessment of Patients ServicesAdditional Requirements for Role in improving performanceSpecific Patient Populations

Management of the

Care of Patients Environment of Care Governance

Planning and Providing Care Design GovernanceAnesthesia Care ImplementationMedication Use Measuring Outcomes of Management

Nutrition Care Implementation ManagementOperative and Oher Procedures Social EnvironmentRehabilitation Care and Services Medical Staff

Special Treatment Procedures Management of Organization, Bylaws, Rules, andHuman Resources Regulations

Education Human Resources Planning CredentialingPatient and Family Education and Orienting, Training, andResponsibilities Educating Staff Nursing

Assessing Competence NursingContinuum Care Managing Staff RequestsContinuity of Care Special Type I recommendation(s)

1 = Substantial Compliance2 = Significant Compliance3 = Partial Compliance4 = Minimal Compliance5 = Non-complianceN = Not ApplicableP = Defer to Primary Service

Summary Grid Score = ________

STRUCTURES WITHFUNCTIONS

PATIENT-FOCUSED FUNCTIONS ORGANIZATION FUNCTIONS ORGANIZATION FUNCTIONSCONTINUED


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.


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.


For example :-1. seven decades ago, The American

College of Surgeons recommended that all surgically removed tissues be routinely reviewed by peers.

2. clinical laboratories in hospitals have maintained accuracy controls for diagnostic tests for long time.

Quality in Health Care Why quality in health care is

more important today ? 1. In order to survive and remain

competitive in today’s business climate.

2. the requirements and expectations of all interested parties must be identified and met.


Additionally, health care organizations must provide consumers and other interested parties with assurance that products and services delivered will meet or exceed their expectations.


Health care quality improvement focuses on the :-

1. improvement of quality.2. increased productivity .

3. more competitive edge in the health care marketplace.


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.


Such as:A. aging population.B. the uninsured. the changing role of

government.C. technological and scientific

advances.D. increased competition and pressure

to be cost-effective.


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.


At first quality was largely defined in terms of structural shortcomings (buildings, equipment, drugs and supplies, staffing).


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.


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 labor-intensive and deal with people that provide and receive a personal service.


The process by which inputs are transformed into outcomes and the desirability of the outcomes are integral parts of the quality dimensions.


Measurement and Determinants of quality :-

1. Definition. 2. norms and value judgments.3. validity issue.


The following four examples of health care definitions illustrate the evolution of the thinking over the past sixty years :-


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”.


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”.


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”.


4. “Total quality management is a management process of continuous improvement – a process of continuously striving to exceed customer expectations.”


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.


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 value-added service to the external customer .

QUALITY IS..

quality comes in the following two forms:

1. Effectiveness : doing the right thing; producing features truly important to the customer.

2. efficiency: doing things right; executing tasks and processes right the first time.

QUALITY IS..

QUALITY EFFECTIVENESS

RIGHTWRONG

EFFIC

IEN

CY

RIG

HT

Right things-done Right

RR

Wrong things-done Right

WR

WR

ON

G

Right things-done Wrong

RW

Wrong things-done Wrong

WW

+

-

+ -

QUALITY IS..

Quality = Doing the right things right consistently to ensure;

1. The best possible clinical outcomes for patients.

2. Satisfaction for all of our many customers.

3. Retention of talented staff.4. Sound financial performance.

QUALITY IS..

conformance

service

Responsibility price

design

safety

delivery

QUALITY

Customer’s perspective;

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

Team-work

Customer satisfaction

Employee empowerment

Process & system improvement

Quality Assurance (QA) versus Quality Management (QM)

QA;

1. Reactive2. Punishing

mistakes3. Meeting

thresholds4. Use fear to

work harder.

5. Department isolated

6. “quality” is undefinable

7. Organization are first

8. Customers are external only (patients).

Quality Assurance (QA) versus Quality Management (QM)

QM;1. Pro-active

(preventive)2. Improving

processes3. Continual

improvement4. Drive out fear.

QM;5. Break down

barriers6. “quality” is exact7. Customer are

first8. Customers are

external and internal (patients and staff).

EIGHT STEPS TO QM

1. Who are our customers?2. What do they need ?3. What do we have to do to

meet their needs?4. What do we measure

(indicators) to know how well we are doing ?

EIGHT STEPS TO QM

5. Gather data /monitor indicators.

6. Analyze data and report results.

7. Identify opportunities for improvement.

8. 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.

Documents

QUALITY DEFINITION Dr. Nasser Ali Al-Jar Allah. Quality Definition “ Quality is often used to signify ‘ excellence ’ of a product or service ”. “ meeting