Quality Improvement Systems in Healthcare Essay

Abstract

Continuous quality improvement (CQI) plays a central role in promoting the quality of goods and services that an organization produces. Many models for improving continuous quality improvement exist. This paper has examined four of the most common CQI models, namely, PDCA, Six Sigma, Lean methodology, and ISO 9000. It illustrates the major advantages and limitations of each model as indicated in various articles and highlights the key differences between them.

PDCA/PDSA

Overview

The PCDA model, also called the Deming cycle, is a four-stage iterative process adopted in industries to improve the quality and efficiency of internal processes. This continuous quality improvement (CQI) concept was first put forward in 1950 by Edwards Deming, who named it the PDSA cycle (the ‘S’ stands for ‘study’). The PDCA cycle consists of four stages, namely, plan, do, check, and act (Matsuo & Nakahara, 2013).

Advantages

1. The PDCA tool is pragmatic, which allows users to experiment small-scale interventions in a cost-effective manner (Matsuo & Nakahara, 2013).
2. Simple – it allows users to do a rapid assessment of changes through four simple steps (Matsuo & Nakahara, 2013).
3. It is flexible and expandable, as new improvements can be made based on feedback data (Chinvigai, Dafaoui & El Mhamedi, 2008).
4. It gives users the “freedom to act and learn”, which reduces risks to clients and minimizes resources needed (Chinvigai et al., 2008, p. 2).
5. It is rigorous like hypothesis testing (data collection and analysis), which reduces the possibility of error (Chinvigai et al., 2008).
6. It generates knowledge for CQI and fosters real-time learning and innovation. The knowledge acquired during one PDCA cycle can be used to change processes or generate a framework for CQI (Matsuo & Nakahara, 2013).
7. It has an in-built ‘check’ mode that allows organizations to evaluate the effect of a process before its completion. This gives firms an opportunity to adjust the process to ensure it meets the targets (Matsuo & Nakahara, 2013).
8. It is comprehensive – it captures all the necessary elements of a process (Bhuiyan & Baghel, 2005).
9. It is engaging – since PDCA is team-focused, it enhances collaboration and teamwork in a firm (Bhuiyan & Baghel, 2005).
10. PDCA is inexpensive, as it directs resources to teams, which avoids additional process costs (Bhuiyan & Baghel, 2005).

Limitations

1. It oversimplifies the CQI process, which makes it unsuitable for large-scale or complex changes (Chinvigai et al., 2008).
2. It is reactive and rigid, as every activity always begins with the planning phase. It is after its execution that problems are corrected (Bhuiyan & Baghel, 2005).
3. It excludes the ‘people’ element, which creates employee resistance to change (Bhuiyan & Baghel, 2005).
4. Only unsatisfactory outcomes at the check stage can make one to ‘act’. This may lead to endless repetitive CA cycles (Chinvigai et al., 2008).
5. Its robustness depends on the ability of the user to avoid assumptions during planning (Bhuiyan & Baghel, 2005).
6. PDCA has inherent flaws and vagueness as it was adapted from Japanese version of PDSA. Differences in cultural contexts affect the application of this concept (Bhuiyan & Baghel, 2005).
7. It can only bring about small-scale additive changes, not large-scale improvements (Bhuiyan & Baghel, 2005).

Six Sigma

Overview

The Six Sigma model is a data-driven CQI method first implemented in the 1980s by Motorola (Andersson, Eriksson & Torstensson, 2006). It uses the DMAIC cycle, i.e., “define, measure, analyze, improve, and control”, to assess the quality of processes in meeting the needs of clients (Andersson et al., 2006, p. 283). It employs statistical data analysis methods to detect failures in processes and reduce variability in product quality.

Advantages

1. The implementation of Six Sigma in manufacturing enhances quality by reducing defects and wastes. Linderman, Schroeder, Zaheer, and Choo (2003) write that the statistical tools ensure that a process runs according to targeted specifications.
2. Six Sigma deployment lowers “production costs and increases efficiency and productivity” by eliminating process defects (Andersson et al., 2006, p. 291).
3. It focuses on the ‘voice of the customer’ to identify process elements that are critical to quality (Linderman et al., 2003)
4. The Six Sigma method facilitates factual decision-making (Andersson et al., 2006).
5. The Six Sigma model is a proactive problem-solving approach (Chinvigai et al., 2008).
6. It is highly adaptable – besides production, it can be used in administrative and design functions (Raisinghani, 2005).
7. It includes human elements (organizational culture) and process components (process data), which leads to project success (Raisinghani, 2005).
8. It involves proven statistical process control tools that are robust and effective (Raisinghani, 2005).
9. The methodology is sequential, which helps identify and resolve problems (Raisinghani, 2005).

Limitations

1. Six Sigma deployment is time consuming and expensive due the extensive data analysis involved (Linderman et al., 2003).
2. The method is not suited for intangible products or health service sector (Linderman et al., 2003).
3. It cannot improve process speed in isolation (Linderman et al., 2003).
4. The definition of a ‘defect’ can be a problem for an organization without quality standards (Raisinghani, 2005).
5. Evaluating the ‘voice of a client’ cannot provide data to improve customer experience (Raisinghani, 2005).
6. Obtaining quality data where none exists is a challenge (Raisinghani, 2005).
7. The award of Black and Green belts does not follow standardized (global) procedures (Raisinghani, 2005).
8. Its emphasis on Black and Green belt certification creates bureaucracy in firms (Raisinghani, 2005).

Lean

Overview

Lean methodology is a CQI model that has its origins in the production environment of Toyota. It entails a process of “reducing waste through continuous improvement” to enhance effectiveness or perfection (Andersson et al., 2006, p. 284). The eight wastes that lean manufacturing aims to eliminate include overproduction, waiting, transportation, excess inventory, surplus motion, underutilized workforce, non-value-added production, and defects (Andersson et al., 2006). To eliminate these wastes, firms employ lean building blocks.

Advantages

1. Reduction in lead times of a production process by as much as 90 percent (Andersson et al., 2006).
2. It leads to improvement in productivity due to waste reduction (Andersson et al., 2006).
3. Lean methodology decreases Work-In-Process (WIP) inventory due to enhanced production efficiency (Swank, 2003).
4. It leads to improvement in the quality of products (Swank, 2003).
5. It leads to a reduction in space utilization because of streamlined production steps (Andersson et al., 2006).
6. It streamlines administrative functions such as customer care, which results in reduced wait times (Andersson et al., 2006).
7. It reduces underutilized human resource, which leads to lower staffing demands (Andersson et al., 2006).
8. Lean production reduces lead times, which serve as a source of competitive advantage for firms (Andersson et al., 2006).
9. Lean production reduces costs/risks associated with employee turnover, documentation, and order processing (Andersson et al., 2006).
10. Lean, if implemented properly, enhances organizational knowledge and learning (Swank, 2003).
11. Lean adds value to a process by ensuring that mistakes (wastes) are not duplicated (Swank, 2003).
12. It enhances employee engagement and ‘ownership’ attitude towards work (Swank, 2003).

Limitations

1. The lean building blocks must be implemented in the correct order to achieve positive results (Keen, 1997).
2. The improvement measures must relate to a firm’s financial statements. However, some metrics do not have a monetary measure (Keen, 1997).
3. It is a complex method because it entails many variables (Andersson et al., 2006).
4. It overlooks some administrative functions, as it mainly focuses on manufacturing environments (Keen, 1997).
5. Implementing lean production requires staff training, which consumes time and resources (Andersson et al., 2006).
6. Lean’s need to minimize inventories requires costly supply chain management to ensure timely delivery (Andersson et al., 2006).
7. It affects organizational culture, hence, prone to employee resistance (Swank, 2003).
8. It lacks strong methodology tools to enhance rigor (Swank, 2003).
9. Lean production in a large firm may be terminated if it outlives the turnover cycle of CEOs (Swank, 2003).
10. Changes in the manufacturing process can affect operational efficiency (Swank, 2003).
11. It relies on centralized expertise to run all equipment. Loss of these operators can affect production (Swank, 2003).

ISO 9000

Overview

ISO 9000 constitutes a group of international standards dedicated to quality management and assurance in different sectors and industries (Gotzamani & Tsiotras, 2001). Its implementation entails creating an ISO 9000 unit, obtaining management commitment, training, evaluating existing quality systems, implementing new systems, and quality auditing (Gotzamani & Tsiotras, 2001).

Advantages

1. The ISO 9000 implementation leads to improvement in internal efficiency (Gotzamani & Tsiotras, 2001).
2. It facilitates quality management, which leads to improved management control (Gotzamani & Tsiotras, 2001).
3. It minimizes costs and wastes due to enhanced internal efficiency (Gotzamani & Tsiotras, 2001).
4. It leads to a clear task structure in an organization, which improves efficiency (Gotzamani & Tsiotras, 2001).
5. It enhances staff motivation, which translates into productivity improvement (Gotzamani & Tsiotras, 2001).
6. ISO certification is a source of competitive advantage for an organization, as it improves a company’s image (Gotzamani & Tsiotras, 2001).
7. It increases sales due to better brand equity and customer satisfaction (Gotzamani & Tsiotras, 2002).
8. Improved customer service (Gotzamani & Tsiotras, 2002)
9. It leads to better suppliers’ quality (Gotzamani & Tsiotras, 2002)
10. It improves cooperation with other firms and international expansion (Gotzamani & Tsiotras, 2002).

Limitations

1. ISO 9000 certification increases administrative costs due to the high paperwork involved (Gotzamani & Tsiotras, 2002).
2. ISO 9000 does not value the need for personnel development to improve quality (Gotzamani & Tsiotras, 2002).
3. It places less emphasis on support functions within a firm; its central focus is on top management commitment (Gotzamani & Tsiotras, 2002).
4. It is rigid and inflexible, which hampers creative thinking and innovation in a firm (Gotzamani & Tsiotras, 2002).
5. Most firms place greater emphasis on ISO 9000 certification at the expense of quality, which limits its benefits (Gotzamani & Tsiotras, 2002).
6. It focuses on quality management at the expense of customer satisfaction.
7. It is less effective in “organic and tacit knowledge based organizations” (Gotzamani & Tsiotras, 2002, p. 157).
8. It may cause internal management issues related to bureaucracy and auditing, if it is not well implemented (Gotzamani & Tsiotras, 2002).
9. External auditors can easily change the certification requirements (Gotzamani & Tsiotras, 2002).

Comparison between different quality improvement systems

References

Andersson, R., Eriksson, H., & Torstensson, H. (2006). Similarities and differences between TQM six sigma and lean. The TQM Magazine, 18, 282-296.

Bhuiyan, N., & Baghel, A. (2005). An overview of continuous improvement: from the past to the present. Management Decision, 43(5), 761-777.

Chinvigai, C., Dafaoui, E., & El Mhamedi, A. (2008). An approach for enhancing process and process interaction capability. 19^thInternational Conference on Production Research, 1, 1-15.

Gotzamani, K., & Tsiotras, G. (2001). An empirical study of the ISO 9000 standards contribution towards total quality management. International Journal of Quality and Reliability Management, 21(10), 326-342.

Gotzamani, K., & Tsiotras, G. (2002). The true motives behind ISO 9000 certification: their effect on the overall certification benefits and long-term contribution towards TQM. International Journal of Quality & Reliability Management, 19(2), 151-169.

Keen, P. (1997). The Process Edge: Creating Values where it Counts. Boston, MA: Harvard Business School Press.

Linderman, K., Schroeder, G., Zaheer, S., & Choo, S. (2003). Six Sigma: A goal-theoretic perspective. Journal of Operations Management, 21(2), 193-203.

Matsuo, M. & Nakahara, J. (2013). The Effect of the PDCA Cycle and OJT on Workplace Learning. The International Journal of Human Resource Management, 24(1), 195-202.

Raisinghani, S. (2005). Six Sigma: concepts, tools, and applications. Industrial Management & Data Systems, 105(4), 491-505

Swank, C. (2003). The lean service machine. Harvard Business Review, 81(10), 123-129.