Basic Concepts of Quality Basic Concepts of Quality Basic Concepts of Quality Basic Concepts of Quality Basic Concepts of Quality Basic Concepts of Quality Basic Concepts of Quality Basic Concepts of Quality

Management Management Management Management Management Management Management Management

FogartyFogartyFogartyFogartyFogartyFogartyFogartyFogarty--------IBRO SchoolIBRO SchoolIBRO SchoolIBRO SchoolIBRO SchoolIBRO SchoolIBRO SchoolIBRO School

NairobiNairobiNairobiNairobiNairobiNairobiNairobiNairobi--------KENYAKENYAKENYAKENYAKENYAKENYAKENYAKENYA

May 22May 22May 22May 22May 22May 22May 22May 22ndndndndndndndnd –––––––– 2525252525252525thththththththth 20072007200720072007200720072007

By By

Ahmed ElAhmed El--Gohary, M.D.Gohary, M.D.

Director, University Center for Quality Assurance, Director, University Center for Quality Assurance,

Prof. Clinical Pathology, Faculty of Medicine,Prof. Clinical Pathology, Faculty of Medicine,

Suez Canal University,Suez Canal University,

Ismailia, EGYPT.Ismailia, EGYPT.

What isWhat is

Management?Management?

Management may be defined as the Management may be defined as the

achievement of organizational goals in an achievement of organizational goals in an

effectiveeffective and and efficientefficient manner through: manner through:

►► planning, planning,

►► organizing, organizing,

►► Leading, Leading, and and

►► Controlling organizational resources.Controlling organizational resources.

1. 1. PlanningPlanning::

�� Defining the Defining the goalsgoals of the organizationof the organization

�� Distribution the Distribution the taskstasks

�� Use the Use the resourcesresources needed to attain them.needed to attain them.

Definition of Management.Definition of Management.

2. 2. OrganizingOrganizing::

�� Assignment of tasks,Assignment of tasks,

�� Grouping of tasks into departments,Grouping of tasks into departments,

�� Allocation of resources to department.Allocation of resources to department.

Definition of Management.Definition of Management.

3. 3. LeadingLeading::

�� MotivateMotivate Staff to achieve the organizational goals.Staff to achieve the organizational goals.

�� Create sharedCreate shared culturescultures & & valuesvalues between staff.between staff.

�� CommunicatingCommunicating goals to staff & employees,goals to staff & employees,

�� Creating the Creating the environmentenvironment of the employees to of the employees to

perform high level. perform high level.

Definition of Management.Definition of Management.

4. 4. ControllingControlling::

�� Monitoring Monitoring employeesemployees’’ activitiesactivities

�� Determine whether the organization is on Determine whether the organization is on target target

�������� goals/goals/�������� making appropriatemaking appropriate corrections corrections if if

necessarynecessary

�� Empowerment and trust of employees... Empowerment and trust of employees...

►► less emphasis on topless emphasis on top--down control & down control &

►►more on training employees to monitor and correct more on training employees to monitor and correct

themselvesthemselves

Definition of Management.Definition of Management.

The managerThe manager’’s responsibility is to coordinate s responsibility is to coordinate

recourses: recourses:

�� HumanHuman, ,

�� FinancialFinancial,,

�� Raw materialsRaw materials...etc...etc

in an in an effectiveeffective and and efficientefficient manner to manner to

a c c o m p l i s h t h e I n s t i t u t i o n g o a l s .a c c o m p l i s h t h e I n s t i t u t i o n g o a l s .

Management.Management.

►►ManagerManager’’s skills require a combination of s skills require a combination of conceptualconceptual, ,

humanhuman and and technical skillstechnical skills..

►► Application of these skills changes as managers Application of these skills changes as managers

move up in organization.move up in organization.

►► The degree of each skill needed will be depending The degree of each skill needed will be depending

on the nature of the Organization/ Institute.on the nature of the Organization/ Institute.

Management Skills.Management Skills.

Why Thinking Why Thinking

Quality?Quality?

►► Due to the high competition Due to the high competition Higher Higher

EducationEducation Institutions/ healthInstitutions/ health are are

challengedchallenged to provide to provide highhigh--qualityquality ((cost cost

effectiveeffective) and to ) and to documentdocument continuously continuously

improvementimprovement for education.for education.

►► Economic constraintsEconomic constraints for Higher education/ for Higher education/

health supporthealth support

What is Quality?What is Quality?

�� There are many short definitions of quality:There are many short definitions of quality:

►► Fitness for use.Fitness for use.

►► Meeting customer expectations.Meeting customer expectations.

►► Doing the right things rightDoing the right things right

►► Two dimensions.Two dimensions.

�� Product features.Product features.

�� Freedom from deficienciesFreedom from deficiencies..

TQM represents a shift from traditional TQM represents a shift from traditional

approaches to qualityapproaches to quality

VI. TOTAL QUALITY MANAGEMENT• Involvement of All: employees, customers, suppliers;

• Empowered of employees;• Teamwork;• Quality strategy based on a common MISSION and VISION• Process oriented.

III. QUALITY ASSURANCE

- Quality systems (ISO) - Quality policy

- Quality planning - Quality costing

- Problem solving

II. QUALITY CONTROL- Quality standards SPC- Process performance - Treating quality problems

I. INSPECTION• Error detection • Rectification

The degree for fulfilling the requirements The degree for fulfilling the requirements expected by the customer.expected by the customer.

►► Quality Control:Quality Control: productproduct--oriented strategyoriented strategy

►► Quality Assurance:Quality Assurance: processprocess--oriented strategyoriented strategy

►► Quality enhancement (CQI):Quality enhancement (CQI): Never ending processNever ending process

►► Total quality management:Total quality management: Deals with all Deals with all

components: components: productproduct –– processprocess –– human resourceshuman resources..

QualityQuality

Quality in HealthQuality in Health

““Degree of which health services for Degree of which health services for

individuals and populations increase the individuals and populations increase the

likelihood of desired health outcomes and likelihood of desired health outcomes and

are consistent with current professional are consistent with current professional

knowledgeknowledge””

Do we need any Do we need any

improvements/improvements/

Quality Management Quality Management

Approaches?Approaches?

Errors in HealthErrors in Health

►► Administrative error in Administrative error in admissionadmission

►► Incorrect or untimely Incorrect or untimely diagnosisdiagnosis

►► Error or Untimely in medication/ therapy/ other Error or Untimely in medication/ therapy/ other treatmenttreatment

►► Administrative error in the patient Administrative error in the patient recordrecord

►► Deviation from Deviation from nursingnursing standardstandard

►► Departure from any other Departure from any other professionalprofessional standardstandard

►► Delayed or administrative error in Delayed or administrative error in dischargedischarge

►► Error in any Error in any financialfinancial statementstatement

►► Error in Error in taketake--homehome instructions or medicationinstructions or medication

What can Quality Do?What can Quality Do?

►► Work to be redesigned,Work to be redesigned,

►► A problem to be solved,A problem to be solved,

►► A change to be instituted,A change to be instituted,

►► A set of processes to be monitored so that A set of processes to be monitored so that any problem can be detected and resolved.any problem can be detected and resolved.

►► There is a systematic method for improving There is a systematic method for improving

the output of the organization the output of the organization �� improving improving

the quality of the system.the quality of the system.

►► The Four features of Quality managementThe Four features of Quality management::

1.1. Preventing errorPreventing error

2.2. Detecting problems Detecting problems

3.3. Solving problemsSolving problems

4.4. ManageningManagening changes changes (long(long--term performance in term performance in

quantitative terms)quantitative terms)..

The results of Quality ManagementThe results of Quality Management

Quality is not only the best way to Quality is not only the best way to attractattract

and and retainretain customers, but it is the key to:customers, but it is the key to:

�� Delighted customersDelighted customers

�� Empowering employees Empowering employees

�� Enhancing revenue, and Enhancing revenue, and

�� Reducing costsReducing costs

The Three Processes of Quality The Three Processes of Quality

ManagementManagement

►►Quality PlanningQuality Planning

�� Used when designing a Used when designing a new servicenew service to insure that the to insure that the

right set of service features are delivered to the right set of service features are delivered to the

appropriate customersappropriate customers

►►Quality ImprovementQuality Improvement

�� Used to Used to reduce the deficienciesreduce the deficiencies in existing services or in existing services or

processes and reaching a new level of performance.processes and reaching a new level of performance.

►►Quality ControlQuality Control

�� Used to ensure that the results of any process is Used to ensure that the results of any process is

sustainedsustained over timeover time

The Three Processes of Quality The Three Processes of Quality

ManagementManagement

Quality Planning Quality Control (During Operations)

Qu

ali

ty

Imp

rovem

ent

Co

st o

f P

oo

r Q

ua

lity

Original Zone of

Quality Control

Chronic Waste

New Zone of

Quality Control

Op

erat

ions

Beg

in

Sporadic

Spike

Time

40

20

0

0

Lessons Learned

MM

EE

SS

UU

RR

EE

Identify a ProjectIdentify a Project

Quality ImprovementQuality Improvement

Replicate Results & Nominate New ProjectsReplicate Results & Nominate New Projects

Hold the GainsHold the Gains

Remedy the CauseRemedy the Cause

Diagnose the CauseDiagnose the Cause

Establish the ProjectEstablish the Project

Nominate projectsA project

“problem scheduled for solution!”

Who identifies projects? What are the sources of information?

1- Senior management

2- Departments’ management

3- A work group

1- Customers

2- Employees

3- Reviews’ audits

4- Other projects

5- Business plans

Selection of ProjectSelection of Project

Criteria for selectionCriteria for selection::

1. Chronicity

2. Significant & Sizable

3. Measure of potential impact

4. Urgency

5. Risk

6. Potential resistance to change

The project !!The project !!

►► To reduce the expenses of SCU Lab by To reduce the expenses of SCU Lab by

15%15%

Pareto Table of Expenses of the Medical Lab.Pareto Table of Expenses of the Medical Lab.

85.185.17.9 7.9 39 84039 840Replacement of Replacement of

equipmentequipment

100 %100 %505 695505 695TotalTotal

1001001.11.15 4615 461MaintenanceMaintenance

98.998.9229 6009 600ElectricityElectricity

96.996.92.82.813 96513 965Printing MaterialsPrinting Materials

94.194.14.24.221 518 21 518 BonusBonus

89.989.94.84.824 39124 391CommunicationsCommunications

77.277.2101050 62850 628LabLab--toto--lablab

67.267.221.221.2107 280107 280SalariesSalaries

46464646233 012233 012Kits and ReagentsKits and Reagents

CumulativeCumulative--% %

of totalof totalPercent of TotalPercent of TotalAmount in LEAmount in LEItem of Item of

expensesexpenses

0

50

100

150

200

250

Kits Salaries Lab-lab Equip. Tel Bonus Printing Electricity Maintenance

Pareto Diagram for Lab Expenses:

11

Measurement

MMeeaall nnoott pprreesseenntt UUnnaavvaaiillaabbllee UUnnaabbllee ttoo ttaakkee tthhee ssaammppllee

MMeeddiiccaattiioonnss UUnnaavvaaiillaabbllee

Storage

NNoott pprreesseenntt mmuullttiippllee ccooppiieess aarree rreeqquuiirreedd UUnncclleeaarr rreeqquuiirreedd llaabb.

Not present Many responsibilities PPoooorr hhaannddwwrriittiinngg

LLaabb tteesstt iiss nnoott iinn

nnoott pprreeppaarreedd tthhee pprriiccee lliisstt UUnnkknnoowwnn aabbbbrreevviiaattiioonnss

Delay at reception Unnecessary steps

Room

Non functioning Delay at sampling Improper sterilization

Computer system or room

Network.

Long handling time

Autoclave Delay at adminstration

Room

PPrroolloonngg ppaattiieennttss wwaaiittiinngg

ttiimmee

Man Materials

Patients

Physicians

Patients

Technician

Accountant

Administrator

Tools

BBiillllss

LLaabb rreeqquueesstt

Prescription

Machine Method

Special preparations

Redraw of samples

►► Key quality leadership tasks:Key quality leadership tasks:�� Setting quality Setting quality goalsgoals

�� Identifying Identifying projectsprojects

�� Selecting Selecting teamsteams

�� Supporting project teamsSupporting project teams::►► Providing education and trainingProviding education and training

►► Providing a trained facilitatorProviding a trained facilitator

►► Approving revision of the project missionApproving revision of the project mission

►► Helping with any problemsHelping with any problems

►► Helping with logistics, such as a meeting siteHelping with logistics, such as a meeting site

►► Providing expertise in data analysis and / or survey designProviding expertise in data analysis and / or survey design

►► Furnishing resourcesFurnishing resources

►► Communicating project resultsCommunicating project results

►►Monitoring progress:Monitoring progress:

Management Support for Quality Management Support for Quality

ImprovementImprovement

►► Quality is never improved in a general way. It is always improveQuality is never improved in a general way. It is always improved d project project

by projectby project, beginning with the , beginning with the most significant problemsmost significant problems..

►► The deficiency to be attacked must be The deficiency to be attacked must be clearly specified clearly specified & the & the expected expected

improvementimprovement can be defined in can be defined in measurable termsmeasurable terms..

►► The team uncovers the The team uncovers the root cause root cause (s) of the deficiency.(s) of the deficiency.

►► Correction of the situation should not simply remove the cause. Correction of the situation should not simply remove the cause. It should It should

produce produce optimal resultsoptimal results..

►► A quality improvement teamA quality improvement team’’s work is not finished until there is a s work is not finished until there is a

procedure in place procedure in place to hold the gainto hold the gain..

►► Replicate the resultsReplicate the results by helping others in the Institute with similar by helping others in the Institute with similar

problems. problems.

1. Choose Control Subjects1. Choose Control Subjects

•• Identify objective of the processIdentify objective of the process

•• Select control subjectSelect control subject

2. 2. Establish MeasurementEstablish Measurement

•• Develop unit of measureDevelop unit of measure

•• Develop sensorDevelop sensor

3. Establish Standards of 3. Establish Standards of

performanceperformance

•• Set targetsSet targets

•• Develop control methodsDevelop control methods

•• Set checking criteriaSet checking criteria

Specific Method Specific Method

To implementTo implement

Quality control Quality control

at at

the working levelthe working level

4. Measure Actual Performance4. Measure Actual Performance

•• Chart indicatorsChart indicators

•• Develop detailed work instructionsDevelop detailed work instructions

FEEDBACKLOOP

5. Compare to standards5. Compare to standards

•• Check resultsCheck results

•• Select appropriate actionSelect appropriate action

6. Take action on the Difference6. Take action on the Difference

•• Analyze processAnalyze process

•• Make contingency plansMake contingency plans

•• TroubleshootTroubleshoot

Not OK?Not OK?

Specific Method Specific Method

To implementTo implement

Quality control at Quality control at

the working levelthe working level

Thank YouThank You