QUALITY PIONEERS
Ignaz Semmelweis
1818 - 1865
• Hungarian physician
in Vienna, Austria
Year
1841
1842
1843
1844
1845
1846
Total
Births
3,036
3,287
3,060
3,157
3,492
4,010
20,042
Physician Clinic
Physician
Deaths Mortality Rate
237
7.8%
518
15.8%
274
9.0%
260
8.2%
241
6.9%
459
11.4%
1,989
9.9%
Births
2,442
2,659
2,739
2,956
3,241
3,754
17,791
Midwife Clinic
Midwife
Deaths Mortality Rate
86
3.5%
202
7.6%
164
6.0%
68
2.3%
66
2.0%
105
2.8%
691
3.9%
Ignaz Semmelweis
1818 - 1865
• Hungarian physician
in Vienna, Austria
Year
1841
1842
1843
1844
1845
1846
Total
Births
3,036
3,287
3,060
3,157
3,492
4,010
20,042
Physician Clinic
Physician
Deaths Mortality Rate
237
7.8%
518
15.8%
274
9.0%
260
8.2%
241
6.9%
459
11.4%
1,989
9.9%
Births
2,442
2,659
2,739
2,956
3,241
3,754
17,791
Midwife Clinic
Midwife
Deaths Mortality Rate
86
3.5%
202
7.6%
164
6.0%
68
2.3%
66
2.0%
105
2.8%
691
3.9%
Mean
Variance
Observations
Pooled Variance
Hypothesized Mean Difference
df
t Stat
P(T<=t) one-tail
t Critical one-tail
P(T<=t) two-tail
t Critical two-tail
Physician
Midwife
Mortality
Mortality
Rate
Rate
0.0985
0.0404
0.0011
0.0005
6
6
0.0008
0
10
3.5797
0.0025
1.8125
0.0050
2.2281
Florence Nightingale
1820 - 1910
• “The Lady with the
Lamp”
• Nightingale's 'Coxcombs‘
Florence Nightingale
1820 - 1910
• Hear her voice:
“When I am no longer even a memory,
just a name, I hope my voice may
perpetuate the great work of my life.
God bless my dear old comrades of
Balaclava and bring them safe to
shore. Florence Nightingale.
• Country Joe McDonald’s
Tribute to Florence
Nightingale
Abraham Flexner
1866 - 1959
• Institute for Advanced Study
• The Flexner Report Medical Education in the
United States and Canada
(1910)
• Download the Report
Source: Regis, E. (1987). Who Got Einstein’s Office. Reading, MA:
Addison-Wesley Publishing.
Ernest Codman
1869 - 1940
• 1895 Graduate of
Harvard Medical School
• The End Results Hospital
• Halifax Harbor Disaster
• Practice Post-WWI
• Quality Legacy
Quality Pioneers
•
•
•
•
•
•
Walter Shewhart
W. Edwards Deming
J. M. Juran
Philip B. Crosby
Koaru Ishikawa
Other Quality Gurus
http://www.bizmanualz.com/blog/top-ten/top-ten-quality-gurus.html
Walter Shewhart
• Father of Statistical Quality Control
http://www.asq.org/join/about/history/shewhart.html
• PDCA Cycle
http://www.hci.com.au/hcisite2/toolkit/pdcacycl.htm
W. Edwards Deming
• 14 Key Principles
– Constancy of Purpose
– Innovation Prized
– Emphasis on Statistical Sampling
– Top Management Commitment
http://www.deming.org/
• 7 Deadly Sins
Source: Sahney et al. “Quality Improvement Process: The Foundation
for Excellence in Health Care.” Journal of the Society for Health
Systems, Vol. 1, No. 1, 1989.
J. M. Juran
• “Fitness for Use”
– Quality as Defined by the Customer
• The Quality Trilogy
– Planning
– Control
– Improvement
• The 10 Step Process
Source: Sahney et al. “Quality Improvement Process: The Foundation
for Excellence in Health Care.” Journal of the Society for Health
Systems, Vol. 1, No. 1, 1989.
Philip B. Crosby
• The Art of Hassle Free
Management
– Management must create the appropriate
environment
– What popular social icon
disputes this as the status
quo?
• Dilbert
http://www.philipcrosby.com/25years/crosby.html
Source: Sahney et al. “Quality Improvement Process: The Foundation
for Excellence in Health Care.” Journal of the Society for Health
Systems, Vol. 1, No. 1, 1989.
Philip B. Crosby
• Quality =
– “Conformance to Requirements” in order to
prevent errors
• Ultimate Goal = “Zero Defects”
Source: Sahney et al. “Quality Improvement Process: The Foundation
for Excellence in Health Care.” Journal of the Society for Health
Systems, Vol. 1, No. 1, 1989.
Philip B. Crosby
• Best Measure = Cost
– Price of Nonconformance
– Price of Conformance
• The 14 Step Process
– Key Point: Management must be committed to
quality and share this commitment with
employees
Source: Sahney et al. “Quality Improvement Process: The Foundation
for Excellence in Health Care.” Journal of the Society for Health
Systems, Vol. 1, No. 1, 1989.
Differences Between The Philosophies
• Defining Requirements for Quality
– Crosby & Juran: The Provider
– Deming: The Customer
Source: Sahney et al. “Quality Improvement Process: The Foundation
for Excellence in Health Care.” Journal of the Society for Health
Systems, Vol. 1, No. 1, 1989.
Differences Between The Philosophies
• Costs
– Crosby & Juran: Standardize the Cost Definition,
Then Monitor
– Deming: Emphasize the Process Definition,
Examine Variations
Source: Sahney et al. “Quality Improvement Process: The Foundation
for Excellence in Health Care.” Journal of the Society for Health
Systems, Vol. 1, No. 1, 1989.
Differences Between The Philosophies
• Role of Authority
– Crosby and Deming: Project Improvement Teams
Determine “Bottom-Up” Selection of Areas to
Focus on Quality
– Juran: Top Down Selection of Teams and Projects
Source: Sahney et al. “Quality Improvement Process: The Foundation
for Excellence in Health Care.” Journal of the Society for Health
Systems, Vol. 1, No. 1, 1989.
Differences Between The Philosophies
• Orientation
– Crosby: Motivation/Culture Change
– Deming and Juran: Use of Statistics
Source: Sahney et al. “Quality Improvement Process: The Foundation
for Excellence in Health Care.” Journal of the Society for Health
Systems, Vol. 1, No. 1, 1989.
Common Concepts
• Top Management Leadership
– Must Drive the Process
• Corporate Framework for Quality
– Quality Must Be Incorporated Into Mission and
Value Statements
– Quality Must Become An Organizational Routine
Source: Sahney et al. “Quality Improvement Process: The Foundation
for Excellence in Health Care.” Journal of the Society for Health
Systems, Vol. 1, No. 1, 1989.
Common Concepts
• Transformation of Current Culture
– Why Is This Important?
• Quality Education and Training
– Necessary At All Levels
– Needed For Employee Orientations And Periodic
Training
– Must Incorporate CQI Tools
Source: Sahney et al. “Quality Improvement Process: The Foundation
for Excellence in Health Care.” Journal of the Society for Health
Systems, Vol. 1, No. 1, 1989.
Common Concepts
• Continuous Improvement in Quality
– New Products And Features
– Reduced Costs To Maintain Same Quality
Source: Sahney et al. “Quality Improvement Process: The Foundation
for Excellence in Health Care.” Journal of the Society for Health
Systems, Vol. 1, No. 1, 1989.
Common Concepts
• Role of the Customer
– Customer’s Requirements Must Be Identified
– Customer’s Satisfaction Must Be Measured And
Monitored
– Complaint Management Systems Must Be Developed
Source: Sahney et al. “Quality Improvement Process: The Foundation
for Excellence in Health Care.” Journal of the Society for Health
Systems, Vol. 1, No. 1, 1989.
Common Concepts
• Focus on System Improvement
– Study Process Variations
– Identify Causes of Error
• Measurement and Experimentation
– Employ CQI Tools
• Pareto Chart/Rule
• Control Chart
• “Fishbone Diagram”
Source: Sahney et al. “Quality Improvement Process: The Foundation
for Excellence in Health Care.” Journal of the Society for Health
Systems, Vol. 1, No. 1, 1989.
Common Concepts
• Quality Management Process
– Must Be Integral to Day-to-Day Operations
• Recognition and Communication
Source: Sahney et al. “Quality Improvement Process: The Foundation
for Excellence in Health Care.” Journal of the Society for Health
Systems, Vol. 1, No. 1, 1989.
Kaoru Ishikawa
• Quality Circles
• The Ishikawa
(“Fishbone”)
Diagram
http://www.bizmanualz.com/blog/top-ten/top-ten-quality-gurus.html
OTHER QUALITY GURUS
QUALITY PIONEERS