Back to Basics. Let’s get our terminology right when talking about QI | Q Community (2024)

Have a look at Juran’s definitions of the word quality:

1. “Quality” means those features of products/services which meet customer needs and thereby provide customer satisfaction. In this sense, the meaning of quality is orientated to income. The purpose of such higher quality is to provide greater customer satisfaction and, one hopes, to increase income. However, providing more and/or better quality features usually requires an investment and hence usually involves increases in costs. Higher quality in this sense usually “costs more”.

2. “Quality” means freedom from deficiencies – freedom from errors that require doing work over again (rework) or that results in field failures, customer dissatisfaction, customer claims, and so on. In this sense, the meaning of quality is oriented to costs, and higher quality usually “costs less”.

The following helps to explain why some meetings on managing for quality end in confusion.

Product features that meet customer needs – Higher quality enables organisations to:

• Increase customer satisfaction
• Make products or services saleable
• Meet competition
• Increase market share
• Provide sales income
• Secure premium prices.

The major effect is on sales. Usually, higher quality cost more.

Freedom from deficiencies – Higher quality enables organisations to:

• Reduce error rates
• Reduce rework, waste
• Reduce field failures, warranty charges
• Reduce customer dissatisfaction
• Reduce inspection, test
• Shorten time to put new products/services on the market
• Increase yields, capacity
• Improve delivery performance.

Major effect is on costs. Usually, higher quality costs less.

They are different but it is important that you know which is being used by your organisation.

Have you heard of Big Q and little q? Are Policy, process and procedure all the same thing? What is the difference between Quality planning, Quality control (QC), Quality assurance (QA)and Quality improvement?

Now have a look at Big Q and little q:

Definition of Big Q andlittle q: Big Q is defined as managing the quality in all business processes, products and services, and small q is defined as mainly product quality with a much narrower scope.

This difference between Big Q and little q is important! Is it understood in the NHS?

This project will produce some materials that can be used by Q members and the wider NHS to inform and educate people in these very important different interpretations of what quality and quality improvement is all about.

The project will undertake some research from within the Q membership to find out whether current quality improvement (QI) activity in the NHS is defined by Big Q or little q. If, as expected, it is found to be little q then this situation needs to change if the Q Community are going to have the desired effect on quality within the NHS.

British industry drives forward ‘Continuous Improvement’, the NHS drives forward ‘Quality Improvement’. Is there a difference?

What is the difference between ‘Quality Improvement’ and ‘Patient Safety’?

I’ve put together a list of the documents that I have found to be most consistent and useful when researching improvement in the NHS. Here it is:

1. Operational productivity and performance in English NHS acute hospitals: Unwarranted variations. An independent report for the Department of Health by Lord Carter of Coles. February 2016 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/499229/Operational_productivity_A.pdf
2. The challenge and potential of whole system flow: Improving the flow of people, information and resources across whole health and social care economies by David Fillingham, Bryan Jones and Penny Pereira. The Health Foundation and AQuA (Advancing Quality Alliance). December 2016 www.health.org.uk/sites/health/files/ChallengeAndPotentialOfWholeSystemFlow.pdf
3. National Safety Standards for Invasive Procedures (NatSSIPs). NHS England patient Safety Domain. 07 September 2015https://www.england.nhs.uk/wp-content/uploads/2015/…/natssips-safety-standards.pdf
4. Getting it Right First Time: Improving the Quality of Orthopaedic Care within the National Health Service in England by Professor Timothy WR Briggs. Royal National Orthopaedic Hospital. September 2012 http://www.gettingitrightfirsttime.com/report/
5. Releasing Time to Care: The Productive Ward series. NHS Institute for Innovation and Improvement. May 2008
6. Organising care at the NHS front line – Who is responsible?. The King’s Fund. May 2017. https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/Organising_care_NHS_front_line_Kings_Fund_May_2017.pdf
7. Quality improvement made simple – What everyone should know about health care quality improvement . The Health Foundation, Quick guide, August 2013. https://s20056.pcdn.co/wp-content/uploads/2018/05/QualityImprovementMadeSimple.pdf

In the words of Don Berwick ‘Go to the gemba’. We can only do that by engaging with the workforce – not patient representatives!

Going to the gemba:

• Use patient feedback to identify top sources of dissatisfaction (or opportunities).

• Assign a team to each process that needs to be redesigned. Give the team special sponsorship and resources.

• Develop and implement improvements in an expedited time frame.

• Use measurements to continually improve the process.

Although this Q Exchange idea has not been shortlisted I do intend to carry on with the project. I will post updates, ask for commentsand publish the final pamphlet via the ‘Process Visualization’ SIG. If you would like to contribute to this important work then please join the SIG. Regards Tom