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With the concepts of Total Quality
Management and Continuous Quality Improvement being introduced to
hospital operations over the last fifteen years, hospital executives
and quality improvement managers have had differing degrees of
success. Knowledge and skill levels have increased as different
methodologies of quality improvement have been studied, transferred
from non-healthcare industries, and implemented in hospitals.
Hospitals have expended enormous fiscal and human resources
implementing leading methodologies, achieving some short-term
successes but then becoming frustrated and uncertain as quality and
cost effectiveness initiatives are not sustained. Executives continue
to be dedicated to quality improvement but are left with the question
– “What is the quality improvement methodology that is right for
success in my organization?”
The
purpose of this analysis is to review four leading quality improvement
methodologies utilized in the market today to help you answer one of
the most important questions that healthcare executives face today–
How do you choose the one that’s right for your organization? The
quality improvement methodologies reviewed in this analysis are:
- Six
Sigma
– Pioneered by Motorola and made famous by General Electric,
this manufacturing methodology focuses on variance reduction
through a problem solving approach that will improve output
quality.
- Lean
Thinking – Touted by Toyota as its key to success, this
methodology strives to reduce waste to improve business
performance through improved workflow.
- Theory
of Constraints – TOC addresses manufacturing system
constraints, emphasizing faster system throughput in system
processes.
- Customer-Inspired®
Quality – Patented by Shaw Resources in 1992, this service
industry methodology focuses on work processes that directly impact
the care and service provided to hospital and medical group patients
by identifying, defining, analyzing, and improving the quality and
effectiveness of processes. It liberally borrows
techniques from each of the three other methodologies.
Comparison of Quality
Improvement Methodologies
Program
|
Six
Sigma
|
Lean
Thinking
|
Theory
of Constraints
|
Customer
Inspired Quality
|
| Theory
|
Reduce
variation
|
Remove
waste
|
Manage
constraints
|
Customer
perspective drives improvements
|
| Target
Organizations |
Manufacturing
|
Manufacturing
|
Manufacturing
|
Service/Healthcare
|
| Focus |
Problems
|
Work
Flow
|
Systems
constraints
|
Customer’s
perspective
|
| Applications
/ Guidelines
|
Define;
Measure;
Analyze;
Improve;
Control.
|
Identify
value;
Identify
value stream;
Flow;
Pull;
Perfection.
|
Identify
constraint;
Exploit
constraint;
Subordinate
processes;
Elevate
constraint.
Repeat
cycle
|
Discover
customer’s perspective of key processes;
Prioritize
processes;
Create
Process
Profile®
graphic;
Identify
measures;
Improve
process;
Review
progress;
Monitor
Customer-Measures;
Repeat
cycle
|
| Assumptions |
A
problem exists;
Fast
throughput;
Less
inventory;
Fluctuation-performance
measures for managers;
Improved
quality.
|
Waste
removal will improve business performance;
Many
small improvements are better then systems analysis.
|
Emphasis
on speed and volume;
Uses
existing systems;
Process
interdependence.
|
Customer
perspective determines the key processes;
Improving
processes that touch customers have the highest impact;
Organizations
that satisfy customers have better financial results.
|
| Primary
impact |
Uniform
process output
|
Reduced
flow time
|
Fast
throughput
|
Improved
customer loyalty and satisfaction
|
| Key
effects |
Less
waste;
Fast
throughput;
Less
inventory;
Fluctuation-performance
measure for managers.
|
Less
variation;
Uniform
output;
Less
inventory;
New
accounting system;
Flow-performance
measures for managers
improved.
|
Less
inventory/waste;
Throughput
cost accounting;
Throughput-performance
measurement system;
Improved
quality.
|
Increased
market share;
Reduced
cost;
Reduced
errors and waste;
Improved
quality;
Increased
employee satisfaction;
Customer
& management performance-measures.
|
| Criticisms |
System
interaction not considered;
Process
improved independently;
Ignores
customer perspective.
|
Statistical
or system analysis not valued;
Ignores
customer perspective.
|
Minimal
worker input;
Data
analysis not valued;
Ignores
customer perspective.
|
Primarily
for service organizations.
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All
the above methodologies rely on application of rigorous statistical
and analytical techniques. Three of the above methodologies were
developed for, and are primarily found in, manufacturing
organizations. Only one of the methodologies, Customer-Inspired
Quality (CIQ), was created for the healthcare service industry,
addressing quality and cost effectiveness from a holistic perspective
as seen by the patient.
Do
the three manufacturing methods bring value to service organizations?
Certainly, addressing specific problems or constraints will definitely
improve quality. However, the manufacturing originated methodologies
approach things first from management’s point of view, not the
customer’s. By employing a ‘management perspective’, it is
difficult, if not impossible, for these methodologies to be used as
the vehicle for attaining top performance in high-touch patient-care
environments or similar service settings.
In
summary, the Shaw Resources’ Customer-Inspired
Quality methodology is the quality and performance improvement
methodology that is best suited for success in healthcare due to the
following reasons:
-
Customer-Inspired
Quality defines all patient
care and administrative work processes so that process
improvement efforts can be prioritized from the customer’s
perspective and a consistent and complete review and approach to
improvement is maintained.
-
The
methodology is hospital / service organization friendly and understandable by all stakeholders (medical staff,
hospital staff, patients, and other care / service providers),
encouraging a broad cross
section of staff input and involvement.
-
It
provides a comprehensive cross-functional
work process review and analysis, addressing all problems and
constraints found in each process or system of care.
-
Administrative
and quality measures are implemented to monitor work process
changes, to bring deviations back in line with process designs,
and to alert managers to process variations before serious adverse
effects occur.
-
Customer-Inspired
Quality takes the quality methods used in manufacturing and adapts
them so that the healthcare industry can successfully
achieve short and long-term improvements in quality, safety, and
customer satisfaction.
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