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

Definitions of Quality ISO 9000- "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".

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

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

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.

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

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

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

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

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

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.

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

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

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

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

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

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.

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

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.

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.

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

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

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

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

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

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

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

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

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

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

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."

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.

Continuous Quality Improvement D A P A P C D Project Difficulty C D Knowledge & Experience

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

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

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

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

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

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.

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.

Improvement Requires Change Needs Action Process Knowledge Requires Experienced People