Introduction to Quality Improvement
QII Leadership
Weekly team informal learning
© Grace L. Duffy, LSSMBB
Quality Advisor
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Definitions of Quality
 ISO 9000- "Degree to which a set of inherent




characteristic fulfills requirements"
Six Sigma - "Uniformity around a target value"
Philip B. Crosby - "Conformance to requirements".
Joseph M. Juran - "Fitness for use". Fitness is defined
by the customer.
Noriaki Kano - A two-dimensional model of quality.
The quality has two dimensions: "must-be quality" and
"attractive quality".
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What Is Quality?
 W. Edwards Deming:
 Meeting customer needs + wants = quality
 Quality improves products/services and processes
 Improved products/services and processes =
profitability
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What Is Quality?
 American Society for Quality
 A subjective term for which each person has his or
her own definition. In technical usage, quality can
have two meanings:


The characteristics of a product or service that bear on its
ability to satisfy stated or implied needs
A product or service free of deficiencies
 The quality of a product or service refers to the
perception of the degree to which the product or
service meets the customer's expectations. Quality
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What Is Quality?
 Today the most progressive view of quality is that it is
defined entirely by the customer or end user and is based
upon that person's evaluation of his or her entire
customer/client experience.
 The client experience is the aggregate of all the touch
points that clients have with the department’s products
and services, and is by definition a combination of these.
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Benefits of Quality
 Tangible
 Intangible
 Increase in services
 Customer/Client
 Decrease in waste
goodwill
 Alignment across
department
activities
 Increase in
productivity
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Benefits of Quality to Employees
 Pride in services delivered
 Job satisfaction
 Improved communications
 Streamlined work processes
 Happier clients
 Strong client relationships
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Benefits of Quality to the Department
 Improved quality of services
 Client oriented employees
 Improved client relations
 Lower costs
 Improved community relations = better political
relations
 Ability to expand services
 Improved funding
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Benefits of Quality to the Client
 Improved quality of services
 Client oriented employees
 Friendlier atmosphere
 Improved choices
 Expectations met or exceeded
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Quality Cycle
 Quality supports dependability
 Dependability supports Speed
 Speed supports Flexibility
 Flexibility supports Cost (Resilience)
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QA and QC
 Quality Assurance which is the "prevention of
defects", such as the deployment of a Quality
Management System and preventative activities
like Failure Mode & Effects Analysis.
 Quality Control which is the "detection of defects",
most commonly associated with testing which
takes place within a Quality Management System
typically referred to as Verification and Validation.
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“Big QI” and “little qi”
Juran’s Quality Handbook
Juran and Gryna 5th edition
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21st Century Definition
"The "total" in total quality indicates a concern for
quality in the broadest sense - what has come to be
known as the "Big Q". Big Q refers to quality of
products, services, people, processes, and
environments. Correspondingly, "Little q" refers to
a narrower concern that focuses on the quality of
one of these elements or individual quality criteria
within an individual element."
Reference: David L. Goetsch and Stanley B. Davis; Quality Management, Introduction to Total Quality management
for Production, Processing, and Services, 3rd edition, Prentice Hall 2000
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Contrast:
little q
Big Q
Topic:
Products
Processes
Services provided to intended
recipients

Processes directly related to
delivery of services to clients

All processes; administrative,
support, clinical, business, etc.

Direct client and community
support

All functions; planning, service,
administration, finance, etc.,
whether for community or
required by regulatory body.

A systemic or global problem

All who are affected by the
activities of public health;
external and internal


Customer
All products, goods, and
services, whether used for
community support or not

Functions
Quality is viewed
as:

A local, county or state problem
Clients who receive value from
services
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Contrast:
little q
Big Q
Topic:
How to think
about Quality

Based on culture of functional
departments

Based on the global approach to
healthy communities
Among goals

In global preventive health
planning

Costs associated with failure to
meet public health needs

All costs that would disappear if all
health conditions were perfect

Conformance to regulatory
specifications, procedures,
standards

Responsiveness to citizen and
stakeholder needs
Quality goals are 
included:
Cost of poor
quality
Evaluation of
quality is based
mainly on:
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Big QI and little qi
 Big QI - managing for quality in all business processes
and services
 little qi - managing for quality in a limited capacity—
traditionally only in services and processes – narrow
focus
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Total Quality Management
 A management approach that originated in the 1950's and
became more popular during the early 1980's.
 Total Quality is a description of the culture, attitude and
organization of a company that strives to provide
customers with products and services that satisfy their
needs.
 The culture requires quality in all aspects of the
organization's operations, with processes being done right
the first time and defects and waste eradicated from
operations.
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Team Discovery
 Rate your own department on the following Big QI and
little qi attributes
 Form into teams. Half the teams do Big QI and half do
little qi rankings on the attributes
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8 Quality Attributes of “Big QI”
1.
Customer focus
Organizations depend on their customers and therefore should
understand current and future customer needs, should meet customer
requirements, and strive to exceed customer expectations.
2.
Leadership
Leaders establish unity of purpose and direction of the organization.
They should create and maintain the internal environment in which
people can become fully involved in achieving the organization’s
objectives.
3.
Involvement of people
People at all levels are the essence of an organization, and their full
involvement enables their abilities to be used for the organization’s
benefit.
4.
Process approach
A desired result is achieved more efficiently when activities and related
resources are managed as a process.
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8 Quality Attributes of “Big QI”
5.
System approach to management
Identifying, understanding, and managing interrelated processes as a
system contributes to the organization’s effectiveness and efficiency in
achieving its objectives.
6.
Continual improvement
Continual improvement of the organization’s overall performance
should be a permanent objective of the organization.
7.
Factual approach to decision making
Effective decisions are based on the analysis of data and information.
8.
Mutually beneficial supplier relationships
An organization and its suppliers are interdependent, and a mutually
beneficial relationship enhances the ability of both to create value.
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8 Quality Attributes of “little qi”
1.
Clear Direction
Senior management has proved clear direction as to the
importance of quality improvement
2.
Process Orientation
Process oriented quality improvement
3.
Training
Organization has provided quality improvement training for all
levels of the organization
4.
Accountability
Process owners accept accountability for their process’s success
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8 Quality Attributes of “little qi”
5.
Metrics
Organization is data driven in all its decision making
6.
Responsibility
Quality improvement is delegated to those closest to the specific
processes
7.
Buy-In
All employees participate and have a positive attitude towards
quality improvement
8.
Daily Management
Employees utilize quality improvement tools and techniques in
their daily work to make it more efficient, less costly, and
customer/client focused
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Rating Your Department
 The next two Radar Charts are designed to help rate our
current state on the attributes of Big QI and little qi.
 For each score you give to an attribute, document “Why” it
was given for future reference
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Rating Your Department
 Rating Scale:
0 – nothing in place
1 – investigating/exploring
2 – minimal/just starting
3 – basics are in place
4 – using it on selected improvement
projects
5 - department-wide use with good results
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Customer
Focus
Supplier
Relations
Leadership
Factual
Approach
Involvement of
People
Process
Approach
Continuous
Improvement
System
Approach
Rate Your Big QI Involvement
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Clear
Direction
Daily
Management
Process
Orientation
Training
Buy-In
Accountability
Responsibility
Metrics
Rate Your little qi Involvement
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Rating Your Department
 The rating on the attributes of “Big QI” and “little qi”
give the department a chance to determine an action
plan since it will have the areas highlighted where we
are doing well and those areas needing improvement
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Juran’s Quality Trilogy
 Quality Planning – build a capable system
 Quality Control – identify where action is required
 Quality Improvement – better ways of doing things
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Juran’s Quality Trilogy
Quality
Control
Holding The Gains
Quality
Planning
Pareto
Analysis
Breakthrough
Quality
Improvement
Project by Project
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Juran’s Quality Trilogy
Quality Control
Quality Improvement
Cost of Poor Quality
Quality Planning
Feedback
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Deming Cycle – PDCA or PDSA
 PDCA was made popular by Dr. Deming who is
considered by many to be the father of modern quality
control; however it was always referred to by him as
the "Shewhart cycle."
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Deming Cycle – PDCA or PDSA
 PDCA should be repeatedly implemented in spirals of
increasing knowledge of the system that converge on
the ultimate goal, each cycle closer than the previous.
 The power of Deming's cycle lies in its apparent
simplicity.
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A
P
C
D
A
P
C
D
A
P
C
D
Project Difficulty
Continuous Quality Improvement
Knowledge & Experience
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Continuous Improvement
Act
Plan
Check
Do
The continuous improvement
phase of a process is how you
make a change in direction.
The change usually is because
the process output is
deteriorating or client needs have
changed
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PDCA
PLAN
 Plan ahead for change
 Creation of the implementation team
 Measurements to show improvement
 Action plans to detail what will be done by who and
when
 Communication plan to inform needed parties of the
changes, timing, and status
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PDCA
DO
 Implement the process improvement initiative -
taking small steps in controlled circumstances
 Get sponsors approval and their support if
implementing means going outside your personal
area of responsibility
 Document the changes so the process can be
duplicated/standardized
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PDCA
CHECK:
 Continually check the results as the process is
initiated and after it is in place to determine if the
changes are meeting requirements
 Determine if the measurements used to determine
success are adequate


If not, define the required measurements and how this data
can be developed
Remember to automate data gathering if at all possible
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PDCA
ACT:
 Take action to standardize or improve the process
 If the process changes are meeting requirements
continue to monitor occasionally
 Standardize the changes – SDCA Cycle
 If the process still isn’t meeting requirements
investigate additional process improvement
opportunities
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Maintenance and Standardization
Act
Standardize
Check
Do
The Maintenance and
Standardization phase of a
process is how we hold the
gains. If our process is
producing the desired
results we standardize
what we are doing.
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Integrated Cycle
The SDCA and PDCA cycles are
separate but integrated.
Once we have made a successful
change we standardize and hold the
gain. When the process is not
performing correctly we go from
SDCA to PDCA and once we have
the process performing correctly we
standardize again.
This switching back and forth
between SDCA and PDCA provides
us with the opportunity to keep our
process customer focused.
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Improvement
Requires
Change
Needs
Action
Requires
Process Knowledge
Requires
Experienced People
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