1. Quality Improvement in
Health Care

2. Quality Improvement
• “The combined and unceasing efforts of everyone- healthcare
professionals, patients and their
families, researchers, payers, planners and educators- to make
the changes that will lead to better patient
outcomes(health), better system performance (care) and
better professional development(learning)”.

3. Six Sigma in Healthcare
• Name comes from the use in statistics of the Greek Letter
(sigma:σ/ς) to denote Standard Deviation from the mean. 6
sigma is equivalent to 3.4 defects or errors per million.
• Six Sigma is a measurement-based strategy for process
improvement and problem reduction completed through the
application of improvement projects. This is accomplished
through the use of two Six Sigma models: DMAIC and DMADV.
• DMAIC (define, measure, analyze, improve, control) is an
improvement system for existing processes falling below
specification and looking for incremental improvement.
• DMADV (define, measure, analyze, design, verify) is an
improvement system used to develop new processor products
at Six Sigma quality levels.

5. • The Six Sigma process is highly measurement and data driven.
Data has to be gathered to determine the baseline
performance of a process in order to validate that an
improvement has been made. Decisions are made on
statistics and facts, rather than instinct or past history.
• The challenge for health care industry to benefit from the use
of Six Sigma is paramount. Patient care significantly involves
human element as compared to machine elements, in which
the variability is subtle and very difficult to quantify.
Therefore, challenge in adopting Six Sigma approach to
healthcare is to find a way to leverage the data from Six Sigma
to drive human behavior. Success will come only when the Six
Sigma technical strategy is combined with a cultural strategy
for change acceleration and a sound operational mechanism.

6. Total Quality Management
• An approach that organizations use to improve their internal
processes and increase customer satisfaction.
• Is a collection of principles, techniques, processes, and best
practices that over time have been proven effective.
• It is used interchangeably with Continuous Quality
Improvement in many areas.

8. Objectives
The main objectives of TQM are:
• Customer Focus
• Scientific approach
• Continuous improvement
• Participation by everyone at all levels

9. Customer focus
• Understanding customer needs by collecting, analyzing and
act on customer information.
Planning process
• Integrating customer knowledge with other information to
come up with new processes to meet the desires of customers

10. Process management
• Develop processes that are stable and capable of meeting
customer expectations.
• Includes reviewing services to ensure they are consistent in
quality standards, to ensure products continue to meet
customer needs.

11. Process improvement
• Continuous improvement of the process to match the
changing customer preferences and demands.
Total participation
• All divisions and employees commit to a customer focus and
desire to produce the best services to meet consumer
demands

12. FADE model of quality improvement
Focus
Analyse
Develop
Execute
Evaluate

13. The FADE-model in practice
Rapid Response Team
-> used FADE in the development of the RRT
• Focus: Had been identified before. To implement a RRT in a
hospital in Kentuckey
• Analyse: Literature review about the topic
• Develop: created an implementation plan and probable
solution. A list of early rescue signs from ‘Failure to rescue’
was made and nurses were educated about the new RRT pilot
• Execute: The goals of the team were presented and the lists
distributed among nurses
• Evaluate: A survey was conducted

14. Medical Microsystems Theory
The microsystem is the logical locus for linkage between vision
and delivery and therefore can and should act as the “agent
for change” within a macrosystem.
The microsystems framework provides practical steps for
designing or redesigning microsystems to perform optimally in
alignment with the strategic plan.

15. Effective microsystems have similar optimal characteristics:
• leadership, culture, macro-organizational support,
• patient focus, staff focus, interdependence of care
• team, information and information technology, process
• improvement, and performance patterns

16. Microsystems thinking makes several organizational
assumptions:
• 1. Bigger systems (macrosystems) are made of smaller systems
• 2. These smaller systems (microsystems) produce
quality, safety, and cost outcomes at the front line of care
• 3. Ultimately the outcomes of the macrosystem can be no
better than the microsystems of which it is composed

17. Collaboration Process
We discussed about the outline and topics in our presentation.
Afterward we divided the tasks and agreed to meet the next day
to discuss our work and the problems we might have
encountered. We discussed some final amendments and made a
final task division. The next morning we agreed to meet early to
discuss our presentation and to inform each other about our
work.

18. Referances
• Department of Community and Family Medicine, Duke University Medical Center
(2005) Patient Safety – Quality Improvement. What is Quality Improvement?
Retrieved on the 3rd of April 2012 from:
http://patientsafetyed.duhs.duke.edu/module_a/module_overview.html
• McFarlan, S.J., Hensley, S. (2007) Implementations and outcome of a rapid
response team. Journal of Nurse Care Quality. Vol. 22, No. 4, pp. 307-313
• Shakti Gupta and Sunil Kant (1999).Total Quality Management and Accredation:
Strategic Essentials for the next Millennium. Retrieved on the 3rd of April 2012
from:
http://www.jkscience.org/archive/Volume22/Total%20Quality%20Management
%20and%20Accreditation.pdf
• Osmond Vitez (2012). Steps in Total Quality Management. Retrieved on the 3rd of
April 2012 from: http://www.ehow.com/about_5414945_steps-total-quality-
management.html
• Kosnik, L. K., Espinosa, J.A. (2003). Microsystems in Health Care:Part 7. The
Microsystem as a Platform for Merging Strategic Planning and Operations. Joint
Commission Journal on Quality and Safety. . Vol. 29, No. 9, pp. 452-459.
Retrieved on the 3rd of April 2012 from:
http://clinicalmicrosystem.org/materials/publications/JQIPart7.pdf

19. • Batalden, P., & Davidoff. F. (2007). What is ¨Quality Improvement¨
And how can it transform healthcare? Qual saf and Health
Care, 16, 2-3. doi:10.1136/qshc.2006.022046
• Reference: Duke University Medical Centre. (2005). Department of
Community & Family Medicine. Patient Safety- Quality
Improvement. Retrieved from
http://patientsafetyed.duhs.duke.edu/module_a/module_overview.
html
• Image retrieved from
http://worldbestonlinepharmacy.com/?wm=17750&tr=8030
• Bandyopadhyay, J., & Coppens., K. (2005). Six Sigma Approach to
Healthcare Quality and Productivity Management. International
Journal of Quality & Productivity Management. 5, 1-13 . Retrieved
from http://condor.cmich.edu/cdm/singleitem/collection/p1610-
01coll1/id/3349/rec/13,

20. Search Strategy
• FADE-model: Search in PubMed and Google Scholar with the
following keywords: FADE-model of Quality
Improvement, Quality Improvement in Health Care, Deming
FADE-model, Deming Quality Improvement, Focus-Analyze-
Develop-Execute model
• Six sigma-model: Searched using Google Scholar and my
university data base search. Used key words like “six-sigma
model, quality improvement, six-sigma model in health care”.