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Using TQM to Make Decisions and Solve Problems in a Healthcare Distribution Center
J Blakeley
Department of Operations Management
APS4020 Applied Quality Management
Dr S Visniski
Assignment Due Date: November 22, 2025
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Using TQM to Make Decisions and Solve Problems in a Healthcare Distribution Center
Total Quality Tools
In a healthcare distribution center managed with Total Quality Management, or TQM,
using established quality tools will ensure processes remain efficient, reliable, and free from
defects. Using insights provided by Goetsch and Davis, as well as Six Sigma and Lean practices,
one can see how these tools allow both monitoring and continuous improvement.
The Pareto chart is a great tool for prioritizing quality issues. This tool uses the 80/20
principle, and visually ranks the frequency of different defect types in descending order so that
the vital few causes stand out visually. In the context of a distribution center, Figure 1 identifies
which categories contribute most to problems. This allows for improvement efforts to be focused
on where the greatest return on efforts can be found.
Figure 1
Pareto Chart (Charlotte, 2024)
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The cause-and-effect, often called Ishikawa or fishbone, diagram is a map of root causes
in structured categories Goetsch and Davis (2021) indicate that these diagrams fosters team
brainstorming and analysis and encourages cross-functional insight. The fishbone diagram in
Figure 2 is meant to allow systematic exploration of potential sources of variation. These
diagrams are one of the seven basic quality tools that are foundational to Six Sigma and Lean
(Barr & Brannan, 2024).
Figure 2
Cause-and-Effect Diagram (Rahardjo & Surya, 2017)
A histogram, as shown in Figure 3, is also an important tool in TQM because it displays
data distribution over intervals. This allows managers to understand how process metrics, like
order fulfillment times or error rates, are spread out. This tool is especially useful in Six Sigma’s
Measure and Analyze phases. Histograms have a way of revealing if a process is tightly centered
or has long tails or skewness (Hill, 2025).
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Figure 3
Histogram (Metabase, 2025)
The run chart, as shown in Figure 4, is meant to track a process metric over time in its
chronological order. This makes any trends, shifts, or cycles easier to spot. Goetsch and Davis
(2021) describe how run charts help detect process behavior before and after improvements are
put into place.
Figure 4
Run Chart (Hessing et al., 2025)
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A control chart, as seen in Figure 5, builds on what a run chart offers by adding statistical
upper and lower control limits. This allows a TQM oriented leader to spot differences between
common cause variation and special cause variation. According to McDermott et al. (2022),
control charts are central to Statistical Process Control (SPC) which is a main component of Six
Sigma quality control. In a healthcare distribution center, control charts monitor picking
accuracy rates, temperature variations in cold-chain storage, and delivery times. They also
trigger action when the process goes out of control zone identified by the limits.
Figure 5
Control Chat (Charlotte, 2024)
A flowchart, like the process map in Figure 6, visually show the steps in a process in
order and call out decision points, loops, and handoffs. Figure 6 shows how materials flow
through a generic concept warehouse. Lean methodology stresses mapping the process to
uncover unnecessary steps, redundancies, or waste to streamline or eliminate excess. Lean Six
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Sigma improvements are often tarted with process mapping or value stream mapping to push for
continuous improvement (Hill, 2025).
Figure 6
Flow Chart (Mecalux, 2019)
Problem Solving and Decision Making
In a TQM environment, especially when combined with a Lean Six Sigma perspective,
problem solving and decision making are closely related but separate processes. Problem solving
is basically about identifying the root cause of an issue and eliminating it. In Six Sigma, this
aligns with the DMAIC (Define Measure Analyze Improve Control) process. An example of this
would be when a distribution center experiences a spike in picking errors, problem solving
would begin with defining the problem (Define), collecting data (Measure), using tools like
Pareto charts or histograms to analyze frequency and distribution (Analyze), suggesting root
causes via fishbone diagrams or similar tools like the 5 Whys, testing action plans (Improve),
and then monitoring with control charts (Control) to ensure stability has been achieved. Goetsch
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and Davis (2021) stress that problem-solving strategies should be structured with the use of
TQM tools like the 5 Whys to trace issues back to their origin.
Decision making is going to refer more to choosing a strategy or solution once the
problem analysis has been completed. In a TQM environment, like a healthcare distribution
center, decisions will involve choosing between investing in automated sorting equipment,
increasing staff training, reorganizing workflow, or implementing poka-yoke processes. Because
these decisions usually have a cost associated with them, as well as a risk level, they should be
driven by data. The Pareto chart can highlight that most errors come from one area, which would
direct resources there. Goetsch and Davis (2021) point out that effective quality managers have
to evaluate alternatives not just based on immediate cost, but on how well they align with longterm goals.
Problem solving is reactive in nature, more of a corrective approach, and decision making
is more proactive and strategic. These overlap in a TQM environment because decision making
based on the info gained in the problem-solving step. Implemented decisions are then validated
through monitoring, often with control charts, to ensure they achieve the needed improvement.
TQM with infusions of Lean and Six Sigma help to build a culture where problem
solving and decision making are shared across teams from all functions, not just management.
Bringing these frameworks together ensures that improvements are sustainable and engrained
into the culture. McDermott et al. (2022) states that healthcare Lean Six Sigma implementations
show that tools like process mapping via flowcharts, Ishikawa diagrams, Pareto charts, and
control charts are the most frequently used, which shows how problem-solving tools directly fuel
the process of strategic decision making.
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Conclusion
In a high stakes environment, like healthcare distribution, using the TQM tools discussed
here give leadership a valuable method that brings understanding to process variations and root
causes. When combined with Lean Six Sigma methodologies, quality minded leadership can
create a disciplined and data-driven approach to making decisions and solving problems. When
an organization stresses continuous improvement and detailed monitoring, it will help to ensure
reliable, high-quality results which translate to minimizing risk, and incfreased customer
satisfaction though building a culture of quality excellence.
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References
Barr, E., & Brannan, G. D. (2024, January 11). Quality Improvement Methods (LEAN, PDSA,
SIX SIGMA). StatPearls - NCBI Bookshelf.
https://www.ncbi.nlm.nih.gov/sites/books/NBK599556/
Charlotte. (2024a, June 22). Control Charts and Purchasing. SPC For Excel.
https://www.spcforexcel.com/knowledge/control-chart-examples/control-charts-andpurchasing/
Charlotte. (2024b, July 5). Pareto Charts. SPC For Excel.
https://www.spcforexcel.com/knowledge/bar-charts-paretos-and-histograms/paretocharts/
Goetsch, D., & Davis, S. (2021). Quality Management for Organizational Excellence:
Introduction to Total Quality (9th ed.). Pearson.
Hessing, T., Pv, R., Hessing, T., & Pv, R. (2025, May 30). Run Chart: Creation, Analysis, &
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McDermott, O., Antony, J., Bhat, S., Jayaraman, R., Rosa, A., Marolla, G., & Parida, R. (2022).
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Mecalux, I. (2019, October 17). Warehouse material flows and flow charts.
https://www.interlakemecalux.com/warehouse-manual/warehouse-design/warehousematerial-flowchart
Metabase. (n.d.). Histograms | Metabase Learn. Metabase | Business Intelligence, Dashboards,
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