1. Introduction to Quality Improvement
QII Leadership
Weekly team informal learning
© Grace L. Duffy, LSSMBB
Quality Advisor

2. Definitions of Quality
ISO "Degree to which a set of inherent characteristic fulfills requirements"
Six Sigma - "Uniformity around a target value"
Philip B. Crosby - "Conformance to requirements".
Joseph M. Juran - "Fitness for use". Fitness is defined by the customer.
Noriaki Kano - A two-dimensional model of quality. The quality has two dimensions: "must-be quality" and "attractive quality".

3. What Is Quality? W. Edwards Deming:
Meeting customer needs + wants = quality
Quality improves products/services and processes
Improved products/services and processes = profitability

4. What Is Quality? American Society for Quality
A subjective term for which each person has his or her own definition. In technical usage, quality can have two meanings:
The characteristics of a product or service that bear on its ability to satisfy stated or implied needs
A product or service free of deficiencies
The quality of a product or service refers to the perception of the degree to which the product or service meets the customer's expectations. Quality

5. What Is Quality?
Today the most progressive view of quality is that it is defined entirely by the customer or end user and is based upon that person's evaluation of his or her entire customer/client experience.
The client experience is the aggregate of all the touch points that clients have with the department’s products and services, and is by definition a combination of these.

6. Benefits of Quality Tangible Intangible Increase in services
Decrease in waste
Increase in productivity
Intangible
Customer/Client goodwill
Alignment across department activities

7. Benefits of Quality to Employees
Pride in services delivered
Job satisfaction
Improved communications
Streamlined work processes
Happier clients
Strong client relationships

8. Benefits of Quality to the Department
Improved quality of services
Client oriented employees
Improved client relations
Lower costs
Improved community relations = better political relations
Ability to expand services
Improved funding

9. Benefits of Quality to the Client
Improved quality of services
Client oriented employees
Friendlier atmosphere
Improved choices
Expectations met or exceeded

10. Quality Cycle Quality supports dependability
Dependability supports Speed
Speed supports Flexibility
Flexibility supports Cost (Resilience)

11. QA and QC
Quality Assurance which is the "prevention of defects", such as the deployment of a Quality Management System and preventative activities like Failure Mode & Effects Analysis.
Quality Control which is the "detection of defects", most commonly associated with testing which takes place within a Quality Management System typically referred to as Verification and Validation.

12. “Big QI” and “little qi”
Juran’s Quality Handbook
Juran and Gryna 5th edition

13. 21st Century Definition
"The "total" in total quality indicates a concern for quality in the broadest sense - what has come to be known as the "Big Q". Big Q refers to quality of products, services, people, processes, and environments. Correspondingly, "Little q" refers to a narrower concern that focuses on the quality of one of these elements or individual quality criteria within an individual element."
Reference: David L. Goetsch and Stanley B. Davis; Quality Management, Introduction to Total Quality management for Production, Processing, and Services, 3rd edition, Prentice Hall 2000

14. Contrast: little q Big Q
Topic:
Products
Processes
Functions
Quality is viewed as:
Customer
All products, goods, and services, whether used for community support or not
All processes; administrative, support, clinical, business, etc.
All functions; planning, service, administration, finance, etc., whether for community or required by regulatory body.
A systemic or global problem
All who are affected by the activities of public health; external and internal
Services provided to intended recipients
Processes directly related to delivery of services to clients
Direct client and community support
A local, county or state problem
Clients who receive value from services

15. Contrast: little q Big Q
Topic:
How to think about Quality
Quality goals are included:
Cost of poor quality
Evaluation of quality is based mainly on:
Based on the global approach to healthy communities
In global preventive health planning
All costs that would disappear if all health conditions were perfect
Responsiveness to citizen and stakeholder needs
Based on culture of functional departments
Among goals
Costs associated with failure to meet public health needs
Conformance to regulatory specifications, procedures, standards

16. Big QI and little qi
Big QI - managing for quality in all business processes and services
little qi - managing for quality in a limited capacity—traditionally only in services and processes – narrow focus

17. Total Quality Management
A management approach that originated in the 1950's and became more popular during the early 1980's.
Total Quality is a description of the culture, attitude and organization of a company that strives to provide customers with products and services that satisfy their needs.
The culture requires quality in all aspects of the organization's operations, with processes being done right the first time and defects and waste eradicated from operations.

18. Team Discovery
Rate your own department on the following Big QI and little qi attributes
Form into teams. Half the teams do Big QI and half do little qi rankings on the attributes

19. 8 Quality Attributes of “Big QI”
Customer focus
Organizations depend on their customers and therefore should understand current and future customer needs, should meet customer requirements, and strive to exceed customer expectations.
Leadership
Leaders establish unity of purpose and direction of the organization. They should create and maintain the internal environment in which people can become fully involved in achieving the organization’s objectives.
Involvement of people
People at all levels are the essence of an organization, and their full involvement enables their abilities to be used for the organization’s benefit.
Process approach
A desired result is achieved more efficiently when activities and related resources are managed as a process.

20. 8 Quality Attributes of “Big QI”
System approach to management
Identifying, understanding, and managing interrelated processes as a system contributes to the organization’s effectiveness and efficiency in achieving its objectives.
Continual improvement
Continual improvement of the organization’s overall performance should be a permanent objective of the organization.
Factual approach to decision making
Effective decisions are based on the analysis of data and information.
Mutually beneficial supplier relationships
An organization and its suppliers are interdependent, and a mutually beneficial relationship enhances the ability of both to create value.

21. 8 Quality Attributes of “little qi”
Clear Direction
Senior management has proved clear direction as to the importance of quality improvement
Process Orientation
Process oriented quality improvement
Training
Organization has provided quality improvement training for all levels of the organization
Accountability
Process owners accept accountability for their process’s success

22. 8 Quality Attributes of “little qi”
Metrics
Organization is data driven in all its decision making
Responsibility
Quality improvement is delegated to those closest to the specific processes
Buy-In
All employees participate and have a positive attitude towards quality improvement
Daily Management
Employees utilize quality improvement tools and techniques in their daily work to make it more efficient, less costly, and customer/client focused

23. Rating Your Department
The next two Radar Charts are designed to help rate our current state on the attributes of Big QI and little qi.
For each score you give to an attribute, document “Why” it was given for future reference

24. Rating Your Department
Rating Scale:
0 – nothing in place
1 – investigating/exploring
2 – minimal/just starting
3 – basics are in place
4 – using it on selected improvement projects
5 - department-wide use with good results

25. Rate Your Big QI Involvement
Customer
Focus
Supplier
Relations 5
Leadership 4 3 2 1
Factual
Approach
Involvement of
People
Process
Approach
Continuous
Improvement
System
Approach
Rate Your Big QI Involvement

26. Rate Your little qi Involvement
Clear
Direction
Daily
Management 5
Process
Orientation 4 3 2 1
Buy-In
Training
Accountability
Responsibility
Metrics
Rate Your little qi Involvement

27. Rating Your Department
The rating on the attributes of “Big QI” and “little qi” give the department a chance to determine an action plan since it will have the areas highlighted where we are doing well and those areas needing improvement

28. Juran’s Quality Trilogy
Quality Planning – build a capable system
Quality Control – identify where action is required
Quality Improvement – better ways of doing things

29. Juran’s Quality Trilogy
Control
Holding The Gains
Quality
Planning
Pareto
Analysis
Breakthrough
Quality
Improvement
Project by Project

30. Juran’s Quality Trilogy
Quality Planning
Quality Control
Quality Improvement
Cost of Poor Quality
Feedback

31. Deming Cycle – PDCA or PDSA
PDCA was made popular by Dr. Deming who is considered by many to be the father of modern quality control; however it was always referred to by him as the "Shewhart cycle."

32. Deming Cycle – PDCA or PDSA
PDCA should be repeatedly implemented in spirals of increasing knowledge of the system that converge on the ultimate goal, each cycle closer than the previous.
The power of Deming's cycle lies in its apparent simplicity.

33. Continuous Quality ImprovementD A P A P C D
Project Difficulty C D
Knowledge & Experience

34. Continuous Improvement
The continuous improvement
phase of a process is how you
make a change in direction.
The change usually is because
the process output is deteriorating or client needs have changed

35. PDCA PLAN Plan ahead for change Creation of the implementation team
Measurements to show improvement
Action plans to detail what will be done by who and when
Communication plan to inform needed parties of the changes, timing, and status

36. PDCA DO
Implement the process improvement initiative - taking small steps in controlled circumstances
Get sponsors approval and their support if implementing means going outside your personal area of responsibility
Document the changes so the process can be duplicated/standardized

37. PDCA
CHECK:
Continually check the results as the process is initiated and after it is in place to determine if the changes are meeting requirements
Determine if the measurements used to determine success are adequate
If not, define the required measurements and how this data can be developed
Remember to automate data gathering if at all possible

38. PDCA ACT: Take action to standardize or improve the process
If the process changes are meeting requirements continue to monitor occasionally
Standardize the changes – SDCA Cycle
If the process still isn’t meeting requirements investigate additional process improvement opportunities

39. Maintenance and Standardization
The Maintenance and
Standardization phase of a
process is how we hold the
gains. If our process is producing the desired results we standardize
what we are doing.

40. Integrated Cycle The SDCA and PDCA cycles are separate but integrated.
Once we have made a successful change we standardize and hold the gain. When the process is not performing correctly we go from SDCA to PDCA and once we have the process performing correctly we standardize again.
This switching back and forth between SDCA and PDCA provides us with the opportunity to keep our process customer focused.

41. Improvement
Requires
Change
Needs
Action
Process Knowledge Requires
Experienced People