Kelly Hampton
Section 2-4
Quality Theorists and Theoretical Frameworks
Quality improvement (QI) has evolved significantly over time and the contributions from theorists in different industries, countries and backgrounds provide a large gamut of principles to help eliminate poor quality. Following World War II, the Japanese developed the philosophy of kaizen . Kaizen is the Japanese word for continuous quality improvement (CQI) and unlike
American QI theories of the time, the Japanese believed that perfection could never be reached and companies should continually endeavor for quality. Considering the many costs of medical errors including, but not limited to, financial, malpractice and public relations costs; it is advisable for Orlando Health (OH) to create an organizational culture of kaizen . This can be accomplished by applying the ideas of quality theorists, Walter Shewhart, W. Edwards Deming and Kaoru Ishikawa and utilizing OH’s already established Lean Six Sigma team to eliminate the incidence of costly medical errors.
As a statistician, Walter Shewhart found that variability occurred in all manufacturing processes. In order to determine if the variability was random or due to assignable cause, he developed quality control charts. W. Edwards Deming’s, a statistics professor who helped
Japanese companies improve quality following World War II, expounded on Shewhart’s work by developing the expressions common cause variation (random) and special cause variation
(assignable) (Reid & Sanders, 2007). Simpson et al., (2005) explain that common cause is an inherent part of all processes while special cause is variation that artificially finds its way into the process. It can be identified due to its irregularity and easily eliminated with the appropriate quality tools. Some may assume that Shewhart’s and Deming’s theories can only be applied to manufacturing processes; however the principles can easily be applied to CQI in the service industry. In order for OH to eliminate the occurrence of medical errors, they must identify the cause for variation and its origin. Once the cause is determined, OH can develop methods to prevent future occurrences and also commit to continuous measurement. Applying these theories should lead to better health outcomes and decreased costs for OH.
While Shewhart and Deming’s are deservingly referred to as the “grandfather and father of quality control”, OH should also consider the works of quality theorist, Dr. Kaoru Ishikawa who played a role in transforming the Japanese industry after WWII to focus on the development high-quality products (Best & Neuhauser, 2008). Known for the creation of fishbone diagrams,
Dr. Ishikawa was the first to recognize the value of the “internal customer” (employee) in the production process (Reid & Sanders, 2007). He also emphasized the importance of total

Kelly Hampton
Section 2-4
Quality Theorists and Theoretical Frameworks company quality control and the participation from all members of the organization. This concept is advantageous in the achievement of OH’s goal to reduce medical errors. As an organization with over 14,000 employees, the possibility for error is likely. In order to apply Dr.
Ishikawa’s theory, OH must involve all employees, encourage communication and development and most importantly, commit to making employees (internal customers) happy. OH employees who are satisfied with their jobs will be more productive and commit to the organization’s CQI efforts. If all OH employees are actively engaged in CQI, it will be easier to identify and eliminate special cause variation of medical error.
Previously mentioned quality theorists, Shewhart and Deming, contributed to the development Lean and Six Sigma, which are widely recognized CQI approaches applied to both manufacturing and service industries. Lean thinking, based on the work of Deming, was developed by Toyota in the 1950’s (Powell, Rushmer & Davies, 2009). Its foundation was formed on Deming’s emphasis on quality improvement in the production process instead of previous mass inspection methods. Powell et al. (2009) explain that the main idea of lean thinking is meeting the needs of the internal or external customer. These needs are what provide value to the customer and under Lean thinking are produced with minimal wasted time, effort and cost. Six Sigma is an approach used to measure the cause of variance in processes and is said to originally been derived from an observation made by Shewhart. A physicist at the time, he found that three sigma (standard deviations) from the mean is the point where a process requires correction (Powell et al., 2009). Six Sigma’s data driven methodology and quality tools allow for organizations to decrease variation in processes and eliminate defects. Due to the successful results, many healthcare organizations are choosing to use a hybrid version combining Lean and
Six Sigma together. United Kingdom’s National Health Service is one of the many who have combined Lean’s focus on eliminating waste and Six Sigma’s data driven analysis to fix errors and defects. OH has a head start in CQI as it already has an established Lean Six Sigma program with team members from clinical and non-clinical backgrounds, such as Clinical Informatics and
Finance (Dr. Khalid Moidu, personal communication, July 7, 2011). Given the existence of OH’s
Lean Six Sigma team, it would be advisable to direct the team’s focus to the elimination of medical error.

References:
Kelly Hampton
Section 2-4
Quality Theorists and Theoretical Frameworks
Best, M., & Neuhauser, D. (2008). Kaoru Ishikawa: from fishbones to world peace. Quality &
Safety in Health Care, 17(2), 150-152. Retrieved from July 6, 2011 from EBSCOhost.
Powell, A., Rushmer, R., & Davies, H. (2009). Effective quality improvement: Six Sigma.
British Journal of Healthcare Management, 15(7), 322-326. Retrieved June 5, 2011 from
CINAHL Plus with Full Text database.
Powell, A., Rushmer, R., & Davies, H. (2009). Effective quality improvement: lean. British
Journal of Healthcare Management, 15(6), 270-275. Retrieved July 6, 2011 from
EBSCOhost.
Reid, R. Dan & Sanders, Nada R. (2007). Operation management: an integrated approach.
Hoboken, NJ: John Wiley & Sons, Inc.
Simpson, D., Roberts, T., Walker, C., Cooper, K., & O'Brien, F. (2005). Using statistical process control (SPC) chart techniques to support data quality and information proficiency: the underpinning structure of high-quality health care. Quality in Primary Care, 13(1), 37-43.
Retrieved July 9, 2011 from EBSCOhost.