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Pierre Barker
Jens Jensen
Nirav Shah
Modern Quality Control
Deming and Berwick
“Cease dependence on inspection to
achieve quality. Eliminate the need for
inspection on a mass basis by building
quality into the product in the first place”
- Out of the Crisis. W. Edwards Deming
“Those of era 2 believe in accountability, scrutiny,
measurement, incentives, and markets. Era 2 has
brought with it excessive measurement, much of
which is useless but nonetheless mandated.”
Dr. Joseph M. Juran’s “Trilogy” 3
QUALITY PLANNING
QUALITY IMPROVEMENT
QUALITY CONTROL
Juran Trilogy: All three elements are
needed
4
PERFORMANCE SHIFT
Chronic waste (opportunity for improvement)
Sporadic spike
Source: Juran J, Godfrey AB, eds. Juran’s Quality
Handbook: Fifth Edition. New York: McGraw-Hill, 1999.
Juran Trilogy: All three elements are
needed
5
PERFORMANCE SHIFT
Chronic waste (opportunity for improvement)
Sporadic spike
Source: Juran J, Godfrey AB, eds. Juran’s Quality
Handbook: Fifth Edition. New York: McGraw-Hill, 1999.
Juran Trilogy: All three elements are
needed
6
PERFORMANCE SHIFT
Chronic waste (opportunity for improvement)
Sporadic spike
Source: Juran J, Godfrey AB, eds. Juran’s Quality
Handbook: Fifth Edition. New York: McGraw-Hill, 1999.
How do we measure and who measures?
Priorities, structures (e.g. Quality Directorate), data systems, learning system, sense making, strategic deployment, building capability
Leadership and Management
Components of quality: planning,
quality control and quality improvement7
Quality
ImprovementMotivation/Leadership
Efficient Systems
Reflective Data
Context-sensitive learning
• Internal monitoring –
continuous measurement
• External Inspection –
intermittent inspection
• Internal and external
regulations
Quality Control IMPROVED
OUTCOMES
New Designs, re-designs
Innovations, new tools in response
to customer needs and experience
Quality Planning
Jens Winther Jensen, MD, Steering Committee Chairman
The Danish Clinical Registries
Senior Fellow Institute for Healthcare Improvement
Welcome to Denmark
Challenges
Economy
New treatments
Expectations and
demand
Variation in outcomes
Patients are hurt
Patientens wishes
often not in line with
physicians
Inequalities in health
Structual activity
Focus in productivity an
economy
Much attention on
defining the whats right
in the clininic
Employees express they
run too fast
11
Hamster Wheel
April 2015: Denmark to stop
hospital accreditation
Bent Hansen,
President of
Danish Regions
'Quality work must be simplified and focused. The time has
come to strengthen it by putting the patient at the centre,
rather than focusing on compliance with a variety of
standards. Accreditation has been justified and useful, but
we move on. We need a few national targets to be met
locally with strong commitment from the staff and with room
for local solutions.'
Grand, J. Le. (2010). Knights and Knaves Return: Public Service Motivation and the Delivery of Public Services. International Public Management Journal, 13(1), 56–71.
Mental Models of GovernancePublic service motivation and the delivery of public services
LeGrand’s Categories
Choice
Voice
Mistrust
Trust
Derek’s Translation
Competition
Patient co-production
Command and control
Collaboration
Grand, J. Le. (2010). Knights and Knaves Return: Public Service Motivation and the Delivery of Public Services. International Public Management Journal, 13(1), 56–71.
A new balance
Quality improvement
Innovation Control
Supervision
Excellent qualityUnacceptablequality
Health Care system units
Control and command Cooperation and trust CompetetionUsers voice
Steering paradigms
Governance review of hospitalsSuggestions for procedures and rules simplification, Maj 2015
Review
An excess of generalised and standardised procedure- and monitoring demands
Employees use a lot of time on tasks which are questioned by employees and their leaders
Implementation overload – not the specific standard or monitoring but the overall burden and trend
Fear of not being accredited has produced a large number of local quality standards and guidelines
Reduced local room for leadership
Quality problems and standards are defined externally
Leadership role reduced to implementation
New Danish Quality Program
- current components
National quality targets
Learning and quality teams
Leadership development program
New extended role of clinical
registries
Quality Control
Routine everyday monitoring part of your management
practice
Role of intermitted external inspection?
Whose responsibility is it?
Government
Healthcare Regions
Hospitals
Administrators
Profession
Measurement for improvement,
research and accountability
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