Healthcare Quality Management

1. METHODOLOGIES &METHODOLOGIES &
TOOLS FOR QUALITYTOOLS FOR QUALITY
MANAGEMENTMANAGEMENT
PresentedPresented
ON QUALITY DAYON QUALITY DAY
ByBy
Dr. Aquil Ahmed KhanDr. Aquil Ahmed Khan
TQM-ACHTQM-ACH

2. This Means:This Means:
Steadily improving each person’s ability to:Steadily improving each person’s ability to:

Recognize and define important problemsRecognize and define important problems PP

Solve themSolve them DD

Learn from problem solvingLearn from problem solving CC
 Share the learning with othersShare the learning with others
AA

3. What is problem?What is problem?

4. Problem solving philosophyProblem solving philosophy

5. MethodologyMethodology
 PDCA-CQIPDCA-CQI
 DMAIC (duh-may-ick)DMAIC (duh-may-ick)
 DMADVDMADV

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7. MethodologyMethodology
• PDCA-CQIPDCA-CQI
• DMAIC (duh-may-ick)DMAIC (duh-may-ick)
• DMADVDMADV
• CQI was originally developed by Walter Shewhart, and isCQI was originally developed by Walter Shewhart, and is
often referred to as the "Shewhart Cycle". It was taken upoften referred to as the "Shewhart Cycle". It was taken up
and promoted effectively from the 1950s by the famousand promoted effectively from the 1950s by the famous
Quality Management authorityQuality Management authority W. Edwards DemingW. Edwards Deming, and is, and is
consequently known by many as "the Deming Wheel".consequently known by many as "the Deming Wheel".

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9. PLAN
Plan carefully what is to be
done
Phase 1 - Identify the
Opportunity
Phase 2 - Analyze the Current
Process
Phase 3 - Develop the Optimal
Solution
DO
Carry out the plan
(do it)
Phase 4 - Implement Changes
CHECK
Check the Results.
Did the plan work as intended
or were the results different?
Phase 5 - Study the Results
ACT
Act on the results by
identifying what worked as
planned and what didn't.
Phase 6 - Standardize the
Solution

10. MethodologyMethodology
• PDCA-CQIPDCA-CQI
• DMAICDMAIC (duh-may-ick)(duh-may-ick)
• DMADVDMADV
DMAICDMAIC is an acronym for five (5) interconnectedis an acronym for five (5) interconnected
phases: Define, Measure, Analyze, Improve andphases: Define, Measure, Analyze, Improve and
Control. It refers to a data-driven quality strategyControl. It refers to a data-driven quality strategy
for improving processes.for improving processes.

11. MethodologyMethodology
• PDCA-CQIPDCA-CQI
• DMAIC (duh-may-ick)DMAIC (duh-may-ick)
• DMADVDMADV
DMADVDMADV consists of five (5) inteconnected phases: Define,consists of five (5) inteconnected phases: Define,
Measure, Analyze, Design and Verify. It is a data-drivenMeasure, Analyze, Design and Verify. It is a data-driven
quality strategy for designing products and processes, It isquality strategy for designing products and processes, It is
also an integral part of a Six Sigma Quality Initiative.also an integral part of a Six Sigma Quality Initiative.

12. IntroductionIntroduction
 In the following we will Examine theIn the following we will Examine the
Techniques and Tools that SupportTechniques and Tools that Support
Quality Management within aQuality Management within a
company. There are for thecompany. There are for the 7 Basic7 Basic
ToolsTools which we are going to define.which we are going to define.
Generally they can be subdividedGenerally they can be subdivided
into:into:
• mathematical statistical Toolsmathematical statistical Tools
• logical toolslogical tools04/30/1404/30/14 Dr. Ashfaq Ahmed BhuttoDr. Ashfaq Ahmed Bhutto 1212

13. 7 Basic Quality Control Tools7 Basic Quality Control Tools
The concept behind the seven basic tools cameThe concept behind the seven basic tools came
from Kaoru Ishikawa, a renowned qualityfrom Kaoru Ishikawa, a renowned quality
expert from Japan. According to Ishikawa, 95%expert from Japan. According to Ishikawa, 95%
of quality-related problems can be resolvedof quality-related problems can be resolved
with these basic tools. The key to successfulwith these basic tools. The key to successful
problem resolution is the ability to identify theproblem resolution is the ability to identify the
problem, use the appropriate tools based onproblem, use the appropriate tools based on
the nature of the problem, and communicatethe nature of the problem, and communicate
the solution quickly to others. Inexperiencedthe solution quickly to others. Inexperienced
personnel might do best by starting with thepersonnel might do best by starting with the
Pareto chart and the cause and effect diagramPareto chart and the cause and effect diagram
before tackling the use of the other tools. Thosebefore tackling the use of the other tools. Those
two tools are used most widely by qualitytwo tools are used most widely by quality
improvement teams.improvement teams.

14. 7 Basic Quality Control Tools7 Basic Quality Control Tools
Basic Quality control tools
1. Cause and effect diagram
2. Control Charts
3. Check sheets
4. Histograms
5. Pareto charts
6. Scatter Diagram
7. Flow Charts
a. Deployment flow charts
b. Linear or activity flow charts

15. HistogramsHistograms
What is it?What is it?
 A Histogram is a bar graphA Histogram is a bar graph
 usually used to present frequency datausually used to present frequency data
How does it Work?How does it Work?
 Define Categories for DataDefine Categories for Data
 Collect Data, sort them into the categoriesCollect Data, sort them into the categories
 Count the Data for each categoryCount the Data for each category
 Draw the Diagram. each category finds its place onDraw the Diagram. each category finds its place on
the x-Axis.the x-Axis.
 The bars will be as high as the value for the categoryThe bars will be as high as the value for the category
What is its use?What is its use?
 Histograms provide an easy way to evaluate theHistograms provide an easy way to evaluate the
distribution of Data over different categoriesdistribution of Data over different categories
04/30/1404/30/14 Dr. Ashfaq Ahmed BhuttoDr. Ashfaq Ahmed Bhutto 1515
LSL USL

16. Pareto ChartsPareto Charts
What is it?What is it?
 A Pareto Chart is a HistogramA Pareto Chart is a Histogram
 + a cumulative line+ a cumulative line
How does it Work?How does it Work?
 Similar like a HistogramSimilar like a Histogram
 First define categories, collect Data and sort them intoFirst define categories, collect Data and sort them into
the Categories. Count the occurrences for each category.the Categories. Count the occurrences for each category.
 Now rank the categories starting with highest value.Now rank the categories starting with highest value.
 Draw cumulative points above all the bars and connectDraw cumulative points above all the bars and connect
them into a line.them into a line.
What is its use?What is its use?
 Pareto Charts are used to apply the 80/20 rule ofPareto Charts are used to apply the 80/20 rule of JosephJoseph
Juran which states that 80% of the problems are the result of 20% of the problems. AJuran which states that 80% of the problems are the result of 20% of the problems. A
Pareto Chart can be used to identify that 20% route causes of problem.Pareto Chart can be used to identify that 20% route causes of problem.
04/30/1404/30/14 Dr. Ashfaq Ahmed BhuttoDr. Ashfaq Ahmed Bhutto 1616
Type
X

17. Pareto ChartsPareto Charts
04/30/1404/30/14 Dr. Ashfaq Ahmed BhuttoDr. Ashfaq Ahmed Bhutto 1717Types of defects
Percentagesofdefectsfound
100%
50%

18. Run ChartsRun Charts
What is it?What is it?
 Run Charts are representing changeRun Charts are representing change
 in measurement over a sequence or timein measurement over a sequence or time
How does it Work?How does it Work?
 Gather DataGather Data
 Organize DataOrganize Data
 Measurements (y) must be confronted with time orMeasurements (y) must be confronted with time or
sequence of the events.sequence of the events.
 Chart DataChart Data
 Interpreting DataInterpreting Data
What is its use?What is its use?
 Determining Cyclic Events and there average characterDetermining Cyclic Events and there average character
04/30/1404/30/14 Dr. Ashfaq Ahmed BhuttoDr. Ashfaq Ahmed Bhutto 1818
Time
Measurement

19. Scatter DiagramsScatter Diagrams
What is it?What is it?
 Statistical tool showing a trend in a series of values.Statistical tool showing a trend in a series of values.
How does it Work?How does it Work?
 Gain values seriesGain values series
 Draw graph with value pointsDraw graph with value points
 Draw trend line: m*x+aDraw trend line: m*x+a
 Calculate m valueCalculate m value
 Calculate a valueCalculate a value
 Calculate points for trend line.Calculate points for trend line.
What is its use?What is its use?
 Demonstrating correlations between values and showingDemonstrating correlations between values and showing
trends for value changes.trends for value changes.
04/30/1404/30/14 Dr. Ashfaq Ahmed BhuttoDr. Ashfaq Ahmed Bhutto 1919
Y
X

20. Control ChartsControl Charts
What is it?What is it?
 Statistical tool, showing whetherStatistical tool, showing whether
 A process is in control or notA process is in control or not
How does it Work?How does it Work?
 Define Upper limit, lower limit and medium valueDefine Upper limit, lower limit and medium value
 Draw Chart.Draw Chart.
 Gather values and draw them into chartGather values and draw them into chart
What is its use?What is its use?
 Taking samples of a process and detect possibility of processTaking samples of a process and detect possibility of process
being out of controlbeing out of control
04/30/1404/30/14 Dr. Ashfaq Ahmed BhuttoDr. Ashfaq Ahmed Bhutto 2020
Y
X
Upper limit
Lower limit
Average/Spec

21. Flow ChartsFlow Charts
What is it?What is it?
 Way of representing a ProcedureWay of representing a Procedure
 using simple symbols and arrowsusing simple symbols and arrows
 A Flowcharts shows the activities in a process and the relationships betweenA Flowcharts shows the activities in a process and the relationships between
them. Operations and Decisions can be representedthem. Operations and Decisions can be represented
How does it Work?How does it Work?
 Determine what Process or Procedure you want toDetermine what Process or Procedure you want to
represent.represent.
 Start at a certain point and go then step by stepStart at a certain point and go then step by step
using circles or rectangles for operations or otherusing circles or rectangles for operations or other
elements, diamonds for decisions, arrows show theelements, diamonds for decisions, arrows show the
flow and the direction.flow and the direction.
 Document the elements with titles. Let it close withDocument the elements with titles. Let it close with
an ending point.an ending point.
What is its use?What is its use?
 A Flow chart lets a process or procedure beA Flow chart lets a process or procedure be
understood easily it also demonstrate theunderstood easily it also demonstrate the
relationships between the elements.relationships between the elements.
04/30/1404/30/14 Dr. Ashfaq Ahmed BhuttoDr. Ashfaq Ahmed Bhutto 2121
Input
Within
Spec?
Process Output
adjust
Yes
No

22. Cause and Effect DiagramsCause and Effect Diagrams
What is it?What is it?
 It’s a diagram that demonstratesIt’s a diagram that demonstrates
 the relationship between Effectsthe relationship between Effects
 and the categories of their causesand the categories of their causes
 The Arrangement of the Diagram lets it look like aThe Arrangement of the Diagram lets it look like a
fishbone it is therefor also called fish-bone diagramfishbone it is therefor also called fish-bone diagram
How does it Work?How does it Work?
 Determine the Effect or Problem you would like toDetermine the Effect or Problem you would like to
examineexamine
 Categorize the possible causesCategorize the possible causes
 find subcategoriesfind subcategories
 Describe the possible causesDescribe the possible causes
What is its use?What is its use?04/30/1404/30/14 Dr. Ashfaq Ahmed BhuttoDr. Ashfaq Ahmed Bhutto 2222
effect
Cause bCause a
Cause dCause c

23. 7 Management and Planning Tools7 Management and Planning Tools
You will learn the essentials of thisYou will learn the essentials of this
toolset to form a powerful andtoolset to form a powerful and
rational system and gain full supportrational system and gain full support
for complex decision making, identifyfor complex decision making, identify
key issues and causes of persistentkey issues and causes of persistent
problems. It will show you ways toproblems. It will show you ways to
involve teams for continuousinvolve teams for continuous
improvements, performance analysisimprovements, performance analysis
and problem solving.and problem solving.

24. 7 Management and Planning7 Management and Planning
ToolsTools
Management and Planning Tools
1. Activity network diagram
2. Affinity Diagram
3. Interrelationship diagram
4. Prioritization matrix
5. Process decision Program chart
6. Tree diagram
7. Matrix Diagram