There are universities that offer courses of study and even actual degrees in quality improvement management. Quality improvement in healthcare (and specifically the DME industry) is integral to accreditation, and more importantly, integral to efficient operation. There are standards that require a DME to incorporate quality improvement (let’s call it “QI” going forward) into their operations. While most managers and owners have a good understanding of the principles and concept of QI, some haven’t heard about the rich history of QI in management and where these principles came from.
In the beginning, there were tradesmen, guys that made barrels, forged iron, shoed horses, baked bread, and so on and so forth. Speeding past a thousand years of progress, the Industrial Revolution changed a lot of that. Technology and advances in tool making and more sophisticated business structure had reached a point where people realized assembly lines were better for manufacturing. Factories and mills replaced the stables, shops, and work sheds where this “industry” had been performed and where stuff was made or repaired.
Decades into this Industrial Revolution, some very bright captains of industry recognized that measuring performance and outcomes statistically would help identify problems and help businesses perform tasks faster, smoother, and more efficiently with less errors. An engineer named Walter Shewhart, who worked at Bell Labs, created a concept of statistical quality control and called it “PDCA” an acronym for “Plan, Do, Check, Act”. This concept involved a cycle that was used for thinking through processes and problems as a way to improve some outcome. The steps in this cycle are:
PLAN: Identify a problem, analyze the root cause, set a goal which he called an expected outcome (which must be something that can be measured and/or quantified), and design an action plan.
DO: Implement the plan to test its effectiveness. Collect operational data (which is why it must something that can be measured).
CHECK: Analyze the collected data and compare performance against an expected outcome (which is why it must be quantifiable).
ACT: Assuming it succeeds and/or meets the goal/expected outcome, implement it across the organization. If it doesn’t succeed, make revisions and restart the cycle. Try again and again until you are satisfied with the outcome.
This became a popular concept and it was taught in management schools and training programs, particularly in the manufacturing industry. For a short period, it was known as the Shewhart Cycle.
Meanwhile, an engineer and statistician named W. Edwards Deming embraced the concept and became associated with it. He worked in industry, and later as a consultant and teacher. The US government used Deming to teach the concept to business leaders in Japan in the years immediately after World War Two to help the Japanese government rebuild their economy. Japanese businesses embraced the concept, which is credited for building their automobile industry into what was considered one of the best in the world in the post-World War Two years. Deming became famous in business and industry circles and Shewhart’s Cycle became the “Deming Wheel” and later the Deming Cycle.
Whether you credit Shewhart or Deming, their concept has been incorporated into business management in almost every industry. Healthcare and DME are no exception and this PDCA cycle is an underlying principle behind the QI standards.
Accreditation expects you to use QI to identify problems through statistical outcome measurement and create fixes or improvements to correct or improve these problems. In DME, we use this cycle to study and monitor issues like customer satisfaction, billing error rates, sentinel and adverse events, customer complaints, timeliness of delivery, staff competency and performance, and profitability. Our industry’s QI processes have helped companies bill more efficiently, address staffing issues, increase productivity, and keep customers happy.
Make sure your staff is aware of this PDCA concept and use it in daily operations. It’s an extremely useful tool to improve the quality of your services.
