Project Management for Healthcare By: David Shirley Chapter 6 Overview of Chapter 6 Brief descriptio

Project Management for Healthcare By: David Shirley Chapter 6 Overview of Chapter 6 Brief description of the chapter focus Chapter 6 Quality DOI: 10.1201/9781003427759-8 Believe it or not, quality initiatives and the focus on quality as we know it today are relatively new endeavors. There are two considerations when managing project quality: (1) the quality of the product of the project, whatever that may be, and (2) the quality of the process for managing the project. Both of those issues will be considered. However, before we get into the considerations, let’s first take a look at the history of quality from a general domestic view, an international view, and finally a specific healthcare environment view. Quality is one of the 12 Project Delivery Principles (see Chapter 2). History of Quality in the United States Traditionally, when manufacturing was in its infancy and major production houses were more like “sweat” shops, inspection was the quality management of choice. Most everything was handmade until Henry Ford put in the first moving assembly line in 1913. Even after that invention, manufacturers continued to use inspection. That was a perfectly plausible approach as long as we had a captive audience for our products. We could afford the scrap involved with inspecting quality in rather than building quality in. The costs of scrapping could be absorbed by increasing the product costs. Even when the first quality efforts were undertaken in the thirteenth century by various guild members, again, that was on a one-to-one basis and the cost of the products reflected the amount of the quality effort. There were actually committees formed to “inspect” goods for flaws. This is still an example of quality by inspection. It wasn’t until early in the twentieth century that “quality gurus” began to surface, studying manufacturing processes and connecting the dots between the quality of the product of the manufacturing process and the process of manufacturing the product. Interestingly, but not so unusual after I explain, AT&T was used as a testing ground for not only quality efforts, but also motivational efforts, as detailed in Chapter 6. Western Electric, the manufacturing arm of AT&T, had a facility known as the Hawthorne Works in Cicero, Illinois, from 1905 until it closed in 1983. Early telephone equipment, the “high tech” electronics at the time, was manufactured there. For the first time, goods were being manufactured requiring skilled labor that needed to deal with tight manufacturing tolerances and high quality. No longer could a manufacturer rely on inspection to insure quality. Walter Shewhart, a Bell Laboratories (AT&T’s research and development arm) engineer, first realized that in order to manage quality, data was needed. Shewhart was also known as the “father of statistical process control.” Using the Hawthorne Works as a testing ground, Shewhart developed statistical process control methods to address data collection and the Shewhart Cycle Learning and Improvement Cycle, “combining both creative management thinking with statistical analysis. This cycle contains four continuous steps: Plan, Do, Study and Act. These steps (commonly referred to as the PDSA cycle)”1 are the precursor to continuous improvement. Around the late 1930s, W. Edwards Deming, working as a mathematical physicist for the U.S. Department of Agriculture (USDA), invited Shewhart to lecture on statistics. I believe that this is when Deming was bitten by the “quality bug.” He was always statistically focused, but now he was combining an extensive knowledge of statistics and mathematics to the new field of quality improvement. While working at the Bureau of the Census in the early 1940s, Deming was asked his opinion on ways to aid the war effort. His advice was to present a short course on Shewhart’s methods. The advice was accepted, and courses were held often with Deming as instructor. The influence of these courses formed the basis of the statistical quality control (QC) movement. Because of his earlier work with the USDA, Deming was sent to Japan to help the war-torn country with repairing its agricultural production. On a later trip, Deming made contact with Japanese statisticians and developed a great relationship with them and other Japanese. Some of the people Deming made contact with were engineers and scientists involved with the reconstruction of Japan’s manufacturing industry. Deming began teaching and consulting statistical process control to the Japanese, who embraced the study and began to apply it to their quality problems. What Deming gave the Japanese was the confidence to pursue quality excellence, and the rest is history. In the meantime, his quality efforts in the United States fell on relatively deaf ears. As a matter of fact, it took nearly 30 years of getting beaten by Japanese automotive quality for Ford Motor Company to “invite” Deming and his ideas into their automotive manufacturing. As a result of instituting Deming’s quality initiatives, Ford became a quality leader capturing the Sport Utility Vehicle (SUV) market with its Ford Explorer during the 1990s. Table 6.1 Quality Trilogy Quality planning • Identify t/he customers. • Determine the needs of those customers. • Translate those needs into our language. • Develop a product that can respond to those needs. • Optimize the product features so as to meet our needs and customer needs. Quality improvement • Develop a process that is able to produce the product. • Optimize the process. Quality control • Prove that the process can produce the product under operating conditions with minimal inspection. • Transfer the process to operations. Another quality “guru” of the time was Joseph Juran, who also helped Japanese quality efforts and has ties to Shewhart, Deming, and AT&T’s Hawthorne Works. In 1926 Juran worked in the new Inspection Statistical Department at the Hawthorne Works, a department championed by Walter Shewhart. Juran worked in the quality management field for more than 70 years. His Quality Control Handbook, first released in 1951, is still used as a reference. “Dr. Juran was the first to incorporate the human aspect of quality management which is referred to as Total Quality Management (TQM).”2 A second book, Quality Is Free, written in 1979, is a seminal work that points out the fact that the expense of quality is outweighed by the benefits of quality efforts, yielding a zero sum. Table 6.13 outlines the major points of Dr. Juran’s quality management ideas. Project Quality Management The Project Management Institute4 provides the following fundamentals for Project Quality Management: project planning, quality assurance (QA), and QC. Project Planning The project planning process includes identifying the relevant project standards—industry, organizational, stakeholder—and how to satisfy those project standards. Industry standards include best practices and regulatory requirements. The organization will likely have its own quality policy, while stakeholders may have more obtuse standards that have to be investigated, including those that drive purchasing decisions. A leading philosophical tenet is that quality must be planned in, not inspected. This is the philosophy that was adopted by those early quality gurus, as opposed to the original quality efforts of allowing quality to be inspected in. Within the planning process certain factors must be considered: cost-benefit analysis including project constraints (cost, schedule, quality, and scope), benchmarking from other similar projects, and the use of other quality tools to be discussed later in this chapter.

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