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RADS 4633 CQI

Module II

Quality Management

Terminal Performance Objective

Upon completion of this unit, the student should be able to identify opportunities for integrating traditional quality assurance models with continuous improvement models.

Enabling Objectives

Upon completion of this unit, the student should be able to:

Identify principles of quality management, including Deming's 14 points.
Identify key roles of the quality manager.
Discuss the attributes and abilities of quality managers.
Describe the components of the PDCA cycle.
Describe the 10 mindset shifts for managing continuous quality improvement.
Perform self-assessments for the Quality Manager mindset.

Introduction

There is no question that unless everyone is involved in a new program, that program has little chance of succeeding. However, do not think that if only one person is involved that no difference can be made; it will just be more difficult. Most importantly, the department must have the appropriate goals in mind, as well as the mindset that will achieve those goals. This unit investigates the principles and attributes of quality management and ties the key roles of the quality manager to those principles and attributes.

Principles of Quality Management

As a working technologist, you are well aware of the influence and effect the department manager has on the entire operation of the department. The integration of continuous quality improvement policies and procedures into everyday working philosophy is an arduous task. Read W. Edwards Deming's 14 Points carefully, and think about how the ideas he presents in each point can be applied in your department. Also, for departments which already have a CQI program in place, it is more difficult to cultivate support for some of these points, especially where quality assurance programs still exist. Bear in mind as you study these points that just because some of them may not be currently applicable to your situation, it does not mean that the department manager is bad or wrong. Even if all points are covered, it also doesn’t necessarily the manager is perfect; these points just reinforce the enormity of the management role.

Deming's 14 Points

Create constancy of purpose for improvement of product and service. Dr. Deming suggests a radical new definition of a company's role: A better way to make money is to stay in business and provide jobs through innovation, research, constant improvement and maintenance.
Adopt the new philosophy. For the new economic age, management needs to take leadership for change into a 'learning organization'. Furthermore, we need a new belief in which mistakes and negativism are unacceptable.
Cease dependence on mass inspection. Eliminate the need for mass inspection by building quality into the product.
End awarding business on price. Instead, aim at minimum total cost and move towards single suppliers.
Improve constantly and forever the system of production and service. Improvement is not a one-time effort. Management is obligated to continually look for ways to reduce waste and improve quality.
Institute training. Too often, workers have learned their job from other workers who have never been trained properly. They are forced to follow unintelligible instructions. They can't do their jobs well because no one tells them how to do so.
Institute leadership. The job of a supervisor is not to tell people what to do or to punish them, but to lead. Leading consists of helping people to do a better job and to learn by objective methods.
Drive out fear. Many employees are afraid to ask questions or to take a position, even when they do not understand what their job is or what is right or wrong. They will continue to do things the wrong way, or not do them at all. The economic losses from fear are appalling. To assure better quality and productivity, it is necessary that people feel secure. "The only stupid question is the one that is not asked."
Break down barriers between departments. Often a company's departments or units are competing with each other or have goals that conflict. They do not work as a team; therefore they cannot solve or foresee problems. Even worse, one department's goal may cause trouble for another.
Eliminate slogans, exhortations and numerical targets for the workforce. These never help anybody do a good job. Let workers formulate their own slogans. Then they will be committed to the contents.
Eliminate numerical quotas or work standards. Quotas take into account only numbers, not quality or methods. They are usually a guarantee of inefficiency and high cost. A person, in order to hold a job, will try to meet a quota at any cost, including doing damage to his company.
Remove barriers to taking pride in workmanship. People are eager to do a good job and distressed when they cannot. Too often, misguided supervisors, faulty equipment, and defective materials stand in the way of good performance. These barriers must be removed.
Institute a vigorous program of education. Both management and the workforce will have to be educated in the new knowledge and understanding, including teamwork and statistical techniques.
Take action to accomplish the transformation. It will require a special top management team with a plan of action to carry out the quality mission. Workers cannot do it on their own, nor can managers. A critical mass of people in the company must understand the 14 points.

The manager and the department as a team must develop a systematic approach to total quality.

Key Roles of the Quality Manager

The keys roles of the quality manager describe how to achieve the transition from philosophy to reality. The steps that follow the key roles are hints and ideas to help you "buy-in" to the philosophy. These roles and steps are not limited in application to just the quality manager, but to every member of the department as well.

It is essential that as you study these roles that you adapt the terminology to fit your situation and that you realize how many different "hats" you wear in your own job. Even though you may not be in a supervisory or administrative position, your ability to function in these roles will greatly affect the outcome of the entire program.

Key Roles

Customer advocate. Managers must make customer satisfaction the ultimate goal. They must demonstrate a willingness and ability to listen to customer expectations, to take them seriously, and to direct processes and people to meet those expectations.
Mobilizer. Quality managers practice what they preach, inspiring others to actively participate and commit to their strong vision. People become part of the goal.
Standard Pusher. Quality managers make sure that key performance is monitored. Accountability is critical and they work hard to improve processes and raise the bar higher and higher.
Change maker. Quality managers love change. They realize that nothing good grows in a static environment. They experiment and inspire others to try new things. They maintain a "can do" attitude.
Partner. Quality managers realize that it is very difficult to do things alone. So they share control, many times giving the control away. The best managers are missed when they take time off, but the whole place does not fall apart. In fact, a good manager should have people waiting to show off new and improved ideas upon their return.
Designer. Quality managers are architects rather than caretakers. They use their ability to listen, observe, and analyze to create and improve new and better ways of doing the right things right.
Facilitator. Quality managers know how to lead people to discover the new and better ways rather than dictating to them. They have a solid understanding of group dynamics so that everyone benefits from participation as well as the ability to help people come together on decisions efficiently and quickly.
Over communicator. The quality manager must listen to all customers and then communicate those needs to everyone. All information must be shared and the manager has to let the mission, vision, goals, progress, problems, trends, costs, successes, failures, and morale be known over and over again so that everyone is on the same page.
Stabilizing force. While quality managers rely on change for improvement, they cannot let themselves get out of control. They must be able to reduce variability in process and outputs and increase reliability. Statistical information can be of great benefit, but it is also important that the manager has experience and firsthand knowledge through observing and consulting with customers. It is much easier to sell an idea that you believe in and understand and helps instill confidence in your workforce.
Team builder and integrator. The quality manager depends on team power, that is, they believe strongly in synergy, or that the whole is greater than the sum of its parts. The ability to blend talents and assist people in bonding with each other and share the vision through recognition and rewards will result in a highly effective and satisfied team.

Steps to Developing the Key Roles

The quality manager has to be smart, unafraid, and very caring to fully and properly use the key roles for the sake of quality. The following steps assist the manager to embrace those roles:

Education. Read, talk to people, and attend workshops and conferences. Find out what the newest things are and what others attribute their success to so that you can avoid reinventing the wheel or making serious mistakes.
Make your vision clear. Your vision and commitment have to be obvious to everyone around you or no one will buy into your philosophy.
Explain your vision. It's not enough that everyone knows your vision statement, they must be able to envision it themselves. All suppliers, customers, and staff must understand it.
Educate the staff. What concepts, attitudes, and tactics do the staff need to use to demonstrate a customer-oriented philosophy? How will it be demonstrated? Let the staff know what is required and where they fit into the scheme of things.
Involve your staff. You need participation in order for the system to work. What better way to get participation than to give the staff a sense of ownership. Have them identify the customers and their expectations, suppliers and their requirements, and the current processes that translate inputs from suppliers into outputs that meet customer needs.
Develop, use, and maintain monitoring and feedback methods. The entire system will fall apart if the information is not gathered and results not made known. It has to mean something to do this project or that survey and staff will lose interest and commitment if nothing happens.
Find opportunities to improve current processes. Learn to follow a straightforward and rational process of planning, doing, checking, and acting (PDCA).
Train staff to do the work. Show staff what to do, be there when there are questions and problems, and use your influence to remove barriers and provide needed resources.
Track progress and results. Recognize individuals and teams who contribute had work and ideas in positive ways.
Stay the course. Don't give up. There will be problems, but do not allow yourself to become absorbed in putting out fires. Involvement of the staff and their ownership will allow them to handle these things before they become insurmountable.

Attributes of the Quality Manager

The traditional department manager handled all of the quality control until quality assurance arrived and a whole new set of roles became apparent. Because quality assurance took into consideration such things as patient outcomes problem-solving no longer was the manager's role as far as people and responsibilities outside of the department were concerned.

You are well aware that if you come to work with a poor attitude, that it is much more likely that you will have a bad day. Likewise, if you come to work with a positive attitude, thing flow more smoothly. The same is true for the quality manager. For a CQI system to work effectively and efficiently the quality manager must have the right mindset and be willing to accept the new roles and responsibilities that the transition to CQI has revealed.

Much like doing the right things right, how willing and able is the manager to effect CQI outcomes. Neither can function alone and the entire organization must be supportive and cooperative.

Willing and able managers constantly develop their skills. Their mindset motivates them to sharpen and utilize their skills to solve real problems and make improvements that increase customer satisfaction.

Willing but unable managers lack the ability or staying power to develop skills despite their drive to contribute.

Unwilling and unable managers do not seek the skills and resist CQI as part of their management duties.

Able but unwilling managers have the skills or the potential but lack the interest or openness to incorporate these skills into everyday actions. The climate and culture of the organization may deflate their motivation to use their skills.

Key Skills for Quality Management-PDCA Model

Having the desire to continually improve services is a major factor towards the success of the CQI program. However, continuous improvement implies continuous change and with those changes come the need for more information and skills.

PDCA Model

Plan

In the plan stage, the manager needs to be able to identify customers and their expectations; to describe the current process geared to meeting these expectations; to develop and apply measurement devices that yield baseline data and theories about possible causes of problems; to determine root causes that will, if attacked, result in a more effective process; to generate feasible improvement ideas and select among them; and to carefully develop a plan to implement the proposed improvement on a trial basis.

Do

In the do stage, the manager needs implementation skills so that he or she can effectively institute the improvement according to plan.

Check

In the check stage, the manager needs to be able to monitor implementation steps, performance dynamics and results so that he or she can draw conclusions about the degree to which the trial-run improvement actually made a positive difference.

Act

In the act stage, the manager needs to have the planning and training skills necessary to develop a plan for integrating process changes into everyday operations so that gains achieved in the short-term are held and built into the process from that time on.

The PDCA cycle is an effective tool for identifying and organizing the necessary skills necessary to make improvements.

To help you understand how the PDCA cycle works, the following problem has been divided into the 12 PDCA steps (remember these steps and think about the tools you could use at each step).

Example

Problem: Outpatients in the waiting room are complaining that they have to wait too long.

Are outpatients waiting too long? Who are the customers and what are the customers' expectations?
Describe "too long". A survey of times is conducted showing the length of time between outpatients arrival and the start of the exam. Average waiting time is shown to be 8.6 minutes. It is believed that this time is not excessive.
Describe the current process. Currently, outpatients come to the window and sign-in. they are told to "have a seat and someone will be right there".
Upon analysis, it appears that patients do not understand why they have to wait, or why some patients who arrive later get taken first. The current process is impersonal.
Improvement opportunity - Find a way to keep patients from feeling forgotten. Identify possible root causes:

No explanation by secretarial staff for long waiting times.
No explanation by technical staff to secretarial staff.
Lack of interest.

Generate and choose solutions

Post signs for patients to remind staff that they are waiting.
Strengthen lines of communication between secretarial and technical staff.
Formulate a policy to ensure patients are not forgotten.

Map out a trial run.

Cover all scenarios
Inform all staff
Implement the trial run

Implement the trial run.

Note pitfalls
Note advantages
Obtain feedback from each participant

Evaluate the results

Compare before and after results
Throw out the useless information, and determine if more information is needed.

Draw conclusions

The evaluation of the results should determine if there was a waiting time problem or if the problem lies in communication only.
From there the proper solutions should be found.

Standardize the change.

Once the proper change has been made, then the solution can be built into the everyday process.
The change needs to cease to be a change and become the norm.

Monitor; hold the gains

Once you have succeeded in making the change, it cannot be forgotten.
Proper checks need to be made to ensure that the process hasn't slipped back to the way it was prior to the change.

As you can see, people must be interested and involved for effective change to take place. Now let’s look at what gets people interested and involved.

Your Mindset

Have you ever stopped to think about why you have just had a bad day? The way you handle what happens to you has a direct effect on the outcome of most situations. The mindset you had at the time of each incident can turn any event into a victory or a defeat.

Read the Leebov and Scott 10 mindset shifts for improved quality. Can you see how shifting the emphasis in each one could affect the outcome of services?

Leebov and Scott 10 Mind-Set Shifts

From tolerance and getting by to continuous improvement
From tolerance and getting by to continuous improvement
From director to coach and empowerer
From provider orientation to customer orientation
From employee as resource to employee as customer
From reactive to proactive
From tradition and safety to experimentation and risk
From "busy-ness" to results
From cynicism to optimism
From turf protection to teamwork across lines

Exercise

Complete the following assessment on yourself and your department manager. Compare the two results.

Mindset Assessment

Mindset Assessment
		A	Each answer is worth 1 pt.	B	Each answer is worth 2 pts.
1.	Are you:		provider oriented		customer oriented
2.	Do you have an:		attitude of just getting by		attitude of continued improvement
3.	I am or would be an manager who is a/an:		director		empowerer
4.	My response to problems is:		reactive		proactive
5.	My approach to problems is:		traditional and safe		risk taker
6.	My goal is for:		everyone to look busy		everyone to get results
7.	I believe in:		managing problems by myself		managing problems through teamwork
8.	I am basically a/an:		cynic		optimist
		__	Total pts.	__	Total pts.

Analyze Your Score

Add up the points for answer columns A and B.
Subtract the number of points in column A from the total number of points in column B.

The highest possible score is 16. The higher the score, the more you already think in ways that support the process of continuous quality improvement. The following questions should help you discover what you can do to become a more quality improvement-minded person:

Think about actions you don't currently take. How can you begin to integrate CQI activities into your daily work ethic? For the actions that you do take, how effective are you?
To what extent are you consistently using the skills in your job? Target as opportunities for continuous self-development those skills that you need to strengthen and apply to the job.
How do you compare to your manager? What skills does your manager lack? How can help yourself and your manager obtain the skills necessary to improve your effectiveness?

Managers and employees who are willing to grow to meet the changing needs of their customers will reap enormous benefits. Although acquiring these skills requires time, dedication, and a willingness to change, the learning experience and realization of the benefits can be very exciting.