BBA (Hospital and Health Systems Management

IV Semester
Quality Assurance in Hospitals
Unit -1
Quality Gurus
1. Edward Deming
2. Joseph Juran
3. Philip Crosby
Deming's 14-Point Philosophy
• Dr. W. Edwards Deming is largely credited with the
focus on quality within business to achieve success.
• A statistician who went to Japan to help with the
census after World War II, Deming also taught statistical
process control to leaders of prominent Japanese
businesses.
• His message was this: By improving quality, companies
will decrease expenses as well as increase productivity
and market share.

• After applying Deming's techniques, Japanese

businesses like Toyota, Fuji, and Sony saw great
success.
• Their quality was far superior to that of their global
competitors, and their costs were lower.

• The demand for Japanese products soared – and by

the 1970s, many of these companies dominated the
global market. American and European companies
realized that they could no longer ignore the quality
revolution.

• Henceforth, the business world developed a new

appreciation for the effect of quality on production and
price.

• He didn't receive much recognition for his work until

1982, when he wrote the book now titled "Out of the
Crisis," which summarized his famous 14-point
management philosophy.
 • Deming’s 14 points have since become a standard
reference for quality transformation.
Note:
• Deming's points apply to any type and size of business.
Service companies need to control quality just as much
as manufacturing companies. The philosophy applies
equally to large multinational corporations, different
divisions or departments within a company, or even
single-person operations.
The 14 Points of Edward Deming for Quality
Improvement
1. Create a constant purpose for improvement
✓ Plan for quality in the long term.
✓ Resist reacting with short-term solutions.
✓ Don't just do the same things better – find better things to
do.
✓ Predict and prepare for future challenges, and always
have the goal of getting better.
✓ Develop a clear and concise quality mission statement
that articulates the organization's commitment to
delivering high-quality products or services.
 ✓ For example, a pharmaceutical company might adopt a
mission to "consistently provide safe and effective
medications to improve patient outcomes."
✓ Ways to establish constancy of purpose:
a) Innovation b) Research and education
c) Continuous improvement of products and
services d) Maintenance of plant and equipment
2. Adopt the New Philosophy
✓ Embrace quality throughout the organization.
✓ Place the business customers' needs first, rather than
react to competitive pressure – and design products and
services to meet those needs.
✓ Be prepared for a major change in the way business is
done. It's about leading, not simply managing.
✓ Create a quality vision for the business, and implement
it.
3. Stop Depending on Inspections
✓ Inspections are costly and unreliable – and they don't
improve quality, they merely find a lack of quality.
✓ Build quality into the process from start to finish.
✓ Don't just find what you did wrong – eliminate the
"wrongs" altogether.
 ✓ Use statistical control methods – not physical inspections
alone – to prove that the process is working correctly.

4. Use a Single Supplier for any one item

✓ Quality relies on consistency – the fewer variations
you(business) have in the input, the less variation you'll
have in the output.
✓ Look at suppliers as your partners in quality.
Encourage them to spend time improving their own
quality – they shouldn't compete for your business based
on price alone.
✓ Analyze the total cost to the business, not just the
initial cost of the product.
✓ Use quality statistics to ensure that suppliers meet
your quality standards.
5. Improve constantly and forever
• Continuously improve your systems and processes.
Deming promoted the Plan-Do-Check-Act approach to
process analysis and improvement.
• PDCA cycle is an iterative process for continually
improving products, people, and services. It became an
integral part of what is known today as Lean
 management. The Plan-Do-Check-Act model includes
solutions testing, analyzing results, and improving the
process.
• PDCA Applications- when to use PDCA?
✓ Developing a new product or service
✓ Optimizing current processes or products
✓ Kicking off a new process improvement project
✓ Exploring new opportunities for continuous
improvement
✓ Implementing change
✓ Detecting process issues and working toward
removing them
• Use kaizen as a model to reduce waste and to improve
productivity, effectiveness, and safety.
6. Use Training and retraining on the Job
✓ Train for consistency to help reduce variations.
✓ Emphasize training and education so everyone can do
their jobs better.
✓ Employees to do their work correctly to enhance
professional development and satisfaction.
✓ Build a foundation of common knowledge.
 ✓ Allow workers to understand their roles in the "big
picture."
✓ Encourage staff to learn from one another, and
provide a culture and environment for effective
teamwork.
7. Institute Leadership
✓ The Management must ensure the supervisors and
managers to understand their workers and the processes
they use.
✓ Don't simply supervise – provide support and
resources so that each staff member can do their best.
Be a coach not a policeman.
✓ Figure out what each person needs to do their best.
For example, hardware, software, other tools, and
training.
✓ Emphasize the importance of participative
management and transformational leadership.
✓ Find ways to reach full potential, and don't just focus on
meeting targets and quotas.
8. Eliminate Fear/Drive out fear
✓ Fear of failure, fear of embarrassment and fear of
blame prohibit capitalizing an opportunity and prevent
people from asking questions or suggesting new ideas.
✓ Allow people to perform at their best by ensuring that
they're not afraid to express ideas or concerns.
✓ Let everyone know that the goal is to achieve high
quality by doing more things right – and that
you're(management) not interested in blaming people
when mistakes happen.
✓ Make workers feel valued, and encourage them to
look for better ways to do things.
✓ Ensure that leaders are approachable and that they
work with teams to act in the company's best interests.
✓ Use open and honest communication to remove fear
from the organization.
9. Break Down Barriers Between Departments
✓ Build the "internal customers" concept – recognize
that each department or function serves other
departments that use their output.
✓ Build a shared vision.
 ✓ Use cross-functional teamwork to build understanding
and reduce adversarial relationships.
✓ Focus on collaboration and consensus instead of
compromise.
10. Eliminate slogans, exhortations and targets for the
workforce
✓ Let people know exactly what you want – don't make
them guess.
✓ The management can generate frustration and resentment
in employees by slogans like “Zero defects” etc.,
✓ "Excellence in service" is short and memorable, but
what does it mean? How is it achieved? The message
is clearer in a slogan like "Always be striving to be
better."
✓ However, don't let words and nice-sounding phrases
replace effective leadership. Outline the management
expectations, and then praise people face-to-face for
doing good work.
11. Eliminate numerical quotas/targets
✓ Look at how processes are carried out, not just numerical
targets.
 ✓ Deming said that production targets can encourage
high output but result in low quality.
✓ Provide support and resources so that both
production levels and quality are high and achievable.
✓ Measure the process rather than the people behind
the process.

12. Remove Barriers to Pride of Workmanship

✓ Top and middle managers must delegate as much
authority as possible to their subordinates to foster
their autonomy
✓ Allow everyone to take pride in their work without being
rated or compared.
✓ Treat workers equally, and don't make them compete
with colleagues for monetary or other rewards. Over
time, the quality system will naturally raise the level of
everyone's work to an equally high level.
13. Implement Education and Self-Improvement
✓ Improve the current skills of workers.
✓ Encourage people to learn new skills to prepare for
future changes and challenges.
 ✓ Build skills to make the workforce more adaptable to
change, and better able to find and achieve
improvements.
14. Make "Transformation" Everyone's Job
✓ Improve the overall organization by having each person
take a step toward quality.
✓ Analyze each small step, and ask how it fits into the
bigger picture.
✓ Use effective change management principles to
introduce the new philosophy and ideas in Deming's 14
points.