In light of our recent discussions about Total Quality Management (TQM) and Quality Assurance (QA), I believe that our best course of action would be to implement Continuous Quality Improvement (CQI). The term Quality Assurance (QA) is often used as an umbrella term which includes Continuous Quality Improvement, rather than as an adjunct to CQI. More generally, however, a distinction is made between the two, with Quality Assurance identified as focusing on outcomes, and Continuous Quality Improvement identified as focusing on processes as well as outcomes (Macdonald, 1997).
Continuous Quality Improvement as compared to Quality Assurance McDonald (1997) provides us with a very clear distinction between Continuous Quality Improvement and Quality Assurance. First of all, Continuous Quality Improvement is a central tenet of management rather than a peripheral activity. CQI focuses on continuously improving rather than on reaching a plateau of quality. Continuous Quality Improvement is a motivating force for improvement rather than a policeman of errors and faults.
It focuses on the system meeting the needs of the consumer rather than individual performance as a foundation. Finally, Continuous Quality Improvement cuts across organizational territories and departmental boundaries. What is Continuous Quality Improvement? Continuous Quality Improvement is a collaborative method that enables people to work together across organizational boundaries to improve shared processes. The focus is on a team approach that rewards the group when things improve. This is a reversal of the culture of blame when things do not go well that we have at our organization.
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The three main components of Continuous Quality Improvement are customer satisfaction, the scientific approach, and the team approach. Some activities of Continuous Quality Improvement are developing and processing surveys and other forms of assessment, facilitating group and team development, improving group and task process, and departmental unit reviews. Traditional quality assurance methods focus on the individual. Continuous Quality Improvement focuses on the organization, systems, and process.
With the use of objective data to analyze and improve processes, improvement is the primary focus for stakeholders, who “can be external or internal to the system – a patient, a payer, a colleague, or someone from another department” (McLaughlin and Kaluzny, 1994). One major premise of Continuous Quality Improvement is that teams are better able than individuals to analyze processes fully. People from different departments and at different levels of the organization will be on the same team. This requires worker involvement, management sponsorship, and the removal of artificial work boundaries.
As a basic management philosophy, Continuous Quality Improvement makes the assumption that most things can be improved. “If it ain’t broke, don’t fix it,” will not work with CQI. At the core of Continuous Quality Improvement is the scientific method applied to everyday work to meet the needs of those we serve and improve the services we offer. We can implement Continuous Quality Improvement by adopting a set of Core Concepts and Steps (Graham, 1995).
Core Concepts of Continuous Quality Improvement
- Quality is defined as meeting and/or exceeding the expectations of our customers.
- Success is achieved through meeting the needs of those we serve.
- Most problems are found in processes, not in people. Continuous Quality Improvement does not seek to blame, but rather to improve processes.
- Unintended variation in processes can lead to unwanted variation in outcomes, and therefore we seek to reduce or eliminate unwanted variation.
- It is possible to achieve continual improvement through small, incremental changes using the scientific method.
- Continuous improvement is most effective when it becomes a natural part of the way everyday work is done.
Core Steps in Continuous Quality Improvement
- Form a team that has knowledge of the system needing improvement.
- Define a clear aim.
- Understand the needs of the people who are served by the system.
- Identify and define measures of success.
- Brainstorm potential change strategies for producing improvement.
- Plan, collect, and use data for facilitating effective decision making.
- Apply the scientific method to test and refine changes.
The overwhelming evidence of the importance of a quality control initiative goes without question.
The issue at hand is which method of Total Quality Management should be implemented. This report has shown that Continuous Quality Improvement would be the most effective method to consider. As Al-Assaf said, “Quality is achieved when the needs and expectations of the customer are met” (1993). With a focus on our customers as well as our employees, we could eliminate our culture of blame. Our new culture would be one of motivated employees working through empowerment, in teams and individually, to continuously improve our products and services for our customers.
This would benefit management, labor, customers, and shareholders. I hope that you will seriously consider Continuous Quality Improvement.
- Al-Assaf, A. F. (1993). Introduction and historical background. In Al-Assaf, A. F. and Schmele, J. A. (Eds. ) The textbook of total quality in healthcare (pp. 3–12).
- Delray Beach, FL: St Lucie Press. Graham, N. O. (Ed. ) (1995). Quality in health care: Theory, application, and evolution. Gaithersburg, MD: Aspen Publishers.
- Macdonald, G. (1997). Quality indicators and health promotion effectiveness. Promotion and Education, IV, 5–8.
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