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Intended Learning Outcomes:
Describe what Quality management.
Differentiate between Quality and Total Quality.
Explain the two types of the customers.
Identify the Triple Role inside any organization.

When you wear blue glasses , you will see whole the world
blue colored , also if you wear a red one , you will see the
world is red , today you will wear the QUALITY Glasses , to
see the world from Quality prospect.
 "To Err Is Human"
At least 44,000 and perhaps as many as 98,000 Americans die in
hospitals each year as a result of medical errors

275 lives lost daily from preventable medical errors

5
1.1 What is Quality?
the most common definition is: (doing the
right things right the first time and
every time + Customer Satisfaction).
 Boeing
providing our Customers with products
and services that consistently meet their
Needs and Expectation.
 The U.S Department of Defense (DOD)
Doing the right thing right the first time,
always striving for improvement, and
always satisfying the Customers.
The Juran institute ,1993 , defines quality
as both :
1.Freedom from Deficiencies
2.Product Features
 1.2 Quality & Total Quality
Total Quality is an approach to doing business that attempts to
maximize the competitiveness of an organization through the
continual improvement of the quality of its products, services,
people, processes, and environments.

The total in total quality known as the Big Q. which 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
 How Total Quality is achieved
Strategically based
Customer focus
Scientific approach to decision making and problem
solving
Long term commitment
Teamwork
Continual process improvement
Education and training
Freedom through control
Unity of purpose
Employee involvement
1.3 Healthcare Quality Definitions
IOM: Quality of care

Quality of care is the degree to which health services for individuals and
population increase the likelihood of desired health outcomes and are
consistent with current professional knowledge.

AHRQ: Quality Healthcare

The U.S. government Agency for Healthcare Research and Quality (AHRQ),
quality healthcare as Healthcare that is Accessible, Effective, Safe,
Accountable, and Fair
Providers deliver the right care to the right patient at the right time in the right
way.
Both patients and clinicians have their rights respected.
1.4 Who are the Customers?

people who buy and use their products and services. They
are the external customers.

There are also internal customers within any organization ((the staff))

External Customers Define Quality and

Internal Customers Produce It.
 68% of the sample values are found within 1 SD, 95%
are found within 2 SD, and 99% are found within 3 SD.

17
 Cause & Effect Diagrams
Sample

Manpower Materials

Typos
Source info incorrect
Wrong source info
Didnt follow proc.

Po
Dyslexic
Wrong purchase order
or
Transposition
t
ra
in
ing Incorrect
shipping
Glare on documents
Temp. display Corrupt
data
No training
Environment
No
procedure Keyboard sticks
No communications

Software problem

Methods Machine
Intended Learning Outcomes:

Describe briefly the history of quality management.

Explain the fourteen points of Deming.
Deming
Describe the future mover in quality management.

Quality must be the number one priority of the organization.

Joseph M. Juran
 2.1 The History of Total Quality Management
Edwards Deming an Joseph M. Juran, two American
experts in quality control
Taiichi Ohno and kaoru Ishikawa, two Japanese developed
Total Quality Control and continuous improvement (kaizen),.
Ohno developed the famed Toyota Production System, created the
concepts of Just-in-Time production and flexible Manufacturing
promoted the goal of total elimination of waste, first formed workers
together in teams with a team leader, created suggestion meetings called
Quality Circles developed the problem-solving system called the
Five Whys to search for root causes, and designed the automation
system to shut down machines automatically if they produce a defective
part.
Ishikawas contributions include the focus on the customer and a very
broad definition of quality-the kaizen daily philosophy and process:

... Quality means quality of work, quality of service, quality of

information, quality of process, quality of division, quality of people,
including workers, engineers,managers, and executives, quality of
company, quality of objectives, etc.(What Is Total Quality Control: The
Japanese Way, 1985)

Fix the problem, not the blame.

Identify the customer and satisfy customer requirements.
Eliminate all waste
encourage teamwork, and create an atmosphere of innovation.
He encouraged participation by all levels of the work force(vertical integration of
quality) as well as by all functions (horizontal integration of quality).

He also merged the ideas of the other gurus with his own and developed
techniques he called the Seven Tools to empower workers: pareto charts,
cause-and-effect diagrams, stratification, the check sheet, the histogram, the
scatter diagram, and Shewhart control charts.
2.2 Edwards Demings Fourteen Points for
Managing Quality

A growing number of healthcare authorities believe that following

Demings 14 points will significantly improve the quality of care
provided to patients. Remember that the principles were first
developed with products in mind, not services. Even though they
have been revised to accommodate the service industry, there is
need for further adaptation in healthcare because a patient is a
person, not a product.
 The Fourteen Points
1.Create constancy of purpose toward improvement of product and service,
with the aim to become competitive and stay in business, and to provide jobs.
2.Adopt the new philosophy Which it is possible for things to be done right
the first time through effective training. It is not quality versus cost. Gains in
quality attract new customers and result in gains in efficiency and productivity,
translating to lower costs.
3.Cease dependence on inspection to achieve quality. Eliminate the need for
inspection on a mass basis by building quality into the product in the first place.
In practice, move inspection as far to the beginning of the process as possible.
Prevent the defect, deficiency, or error.

Healthcare cannot cease monitoring because we have a unique duty of care to our
patients that is both legal and moral in nature. However, we can focus more on
systems than individuals and can place much more emphasis on improving services
than finding fault. We can move process measurement and some record review
activities to concurrent, and move patient/customer needs data collection even more
prospective, relying on retrospective data for patterns, trends, and sentinel events.
4.End the practice of awarding business on price tag
alone. Instead, minimize total cost. Move toward a single supplier for
anyone item, on a long-term relationship of loyalty and trust.
5. Improve constantly and forever every process for
planning, production, and service, to improve quality and productivity,
and thus constantly decrease costs. Train employees to look for and
know how to make improvements; give them the authority to do so.
6. Institute training on the job. Deming: employees are an institutions most
precious assets and must be led, not driven, by management. Train employees to
know what the job is, why it is being done, and how to improve it.
7. Adopt and institute leadership. The aim of leadership should be to help people
and machines and gadgets to do a better job. Leading consists of helping people do
a better job and of learning by objective methods who is in need of individual help.
8. Drive out fear, so that everyone may work effectively for the company. It is
necessary for better quality and productivity that people feel secure.
9. Break down barriers between staff areas. Emphasize teamwork, not
competition. Every healthcare delivery system is made up of interconnected
processes, each of which has a supplier of input and a customer to receive the
output. Every employee must strive to meet the needs and expectations of
customers, those internal as well as external.
10.Eliminate slogans, exhortations, and targets for the work force.
These never helped anybody do a good job. Concentrate on improving
the system to make it easier for the worker to do a better job.
11.Eliminate numerical quotas for the work force and numerical
goals for management.
Emphasize quality and methods, not quantity, to increase employee.
Substitute Leadership.
12. Remove barriers that rob people of pride of workmanship.
Eliminate the annual rating or merit system. Too often, misguided
supervisors, faulty equipment, and defective materials or processes
stand in the way. Financial remuneration tied to isolated performance
assessment may ignore the workers sense of pride in a job well done.
13. Institute a vigorous program of education and self-
improvement for everyone. Quality begins and ends with
education. Keep minds working.
14. Put everyone to work to accomplish the transformation.
Quality improvement means all employees trying every day to
do their jobs better , not merely trying to attain or maintain a
minimal level of competence to satisfy the manager or the QM
department. The transformation is everyones job.
2.3 WHERE IS QUALITY GOING NEXT

Technical Quality (roots in manufacturing-i.e., products)

Focus: Internal products for processes

Measure: Doing things right
Driver: Cost
Relies on: Quality tools, process, &
technology
Customer Perspective: persuade them
Functional Quality (contribution of service industry)

Focus: External customers

Measure: Customer satisfaction

Driver: process
Relies on: people & judgment
Customer Perspective: Satisfy them
Competitive Quality (more than products & existing customers)

Focus: Total market

Measure: Market share
Driver: Value
Relies on: Time & flexibility
Customer Perspective: Attract them
Forward Quality (innovation)
Focus: New markets
Measure: New product/service offerings
Driver: Innovation
Relies on: Long term planning, intuition, "breakthrough
Customer Perspective: Build trust