QUALITY CONCEPTS

Ola H. ElgaddarMBChB, MSc, MD, CPHQ, LGBSS 

Lecturer of Chemical Pathology Medical Research Institute

Alexandria UniversityOla.elgaddar@alex-mri.edu.eg

We are what we repeatedly do, excellence, then, is not an act but

a habit

The definition of

insanity is continuing

to do the same thing

over and over again

and expecting a different result!!

Quality

Doing the right thing right, from the first time and every time!

Healthcare quality

The right care for every person, every time!

Dimensions of Quality

• Safe• Timely• Effective• Efficient• Equitable• Patient centered

Change in emphasis

In the past the focus was on:- The "WHAT" of care: Patient care given

- The "WHO" of care: Patient care giver

Now, the primary focus is on:- The "HOW" of care: Patient care process

- The "Result" of care: Patient care outcome

VALUE = QUALITY + OUTCOME

COST

Cost of poor quality!!

Management

It is the act of getting people together to accomplish desired goals and objectives using available resources efficiently and effectively

Total Quality Management (TQM)An organization wide management philosophy and top - level commitment to provide "value" to all customers through:

- Creating an environment of continuous improvement of people skills and processes

- Building excellence into every aspect of the organization

TQM philosophy promotes:

• Increase top down and bottom up emphasis on quality

• Decreased emphasis on inspection• Increased investment in education• Continuous, ongoing quality

improvement

Shewhart

-American engineer & statistician- Inspection?!- SPC- Shewhart cycle

-American Statistician- In Japan (When it was like China), he taught top management how to improve design and thus the product (Through SPC)

Japanese Vs American!!!!

-American management consultant and engineer -In Japan, he worked in parallel with Deming (Management for quality)- Used Pareto

JURAN

Quality is fitness for use!

Ishikawa- A Japanese quality management innovator-QA emphasizing the customer-Quality first not short term profit

Management philosophy: Respect for humanity

POKA -YOKE

To err is human

- IOM, November 1999- Building a safer health system- More commonly, errors are caused by

faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them.

- http://iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

Shigeo Shingo

POKA - YOKE

Poka – Yoke“Error proof”

- Its origin in the Japanese language from the words “poka” (which means inadvertent mistake) and from “yoke” (which means to prevent)

- Shigeo Shingo’s responsibility was managing the statistical process control in the Toyota production system in Japan during the 1950’s

Categories of poka-yoke devices

I) Preventive:

Design the process making it impossible to make mistakes

Categories of poka-yoke devices

II) Detection:

Signals the user when a mistake has been made, so that the user can quickly correct the problem

Accreditation

An institution or a program meets standards of quality set forth by an accrediting agency

JCI worldwide

• Brazil: 25• China: 20• India: 18• Jordon: 9• Qatar: 5• KSA: 49• Singapore: 14• Thiland: 23• Turkey: 41• UAE: 41