A Strategy for Continuous Quality Improvement

When implementing a quality improvement program, there are various strategies of program maintenance that can be used.  One specific strategy, introduced in the 1920s by Walter A. Shewart, and expanded upon in the 1950s by W. Edwards Deming, is the Plan-Do-Check-Act (PDCA) Cycle (Arveson, 1998).  Most current models of improvement are based upon this method; and therefore it can be considered a starting point for organizations in need of improvement (Ransom, Joshi, Nash, & Ransom, 2008).

It was Deming’s belief that organizational processes should be routinely evaluated; he thought this necessary to identify the origins of possible failures and inconsistencies in the processes (Arveson, 1998).  The PDCA, also referred to as The Shewhart Cycle, The Deming Cycle, and the Plan-Do-Study-Act (PDSA) cycle, should be a continuous action, on the part of the organization, that helps standardize routine evaluations by using its four elements (Tague, 2004).

In the first phase of the cycle, the planning phase, an organization is encouraged to design a plan for improvement, or revise an existing one (Arveson, 1998).  Here, it is suggested that ideas are gathered, and expectations and objectives are set based upon where you are and where you want to be, using the four W’s (Ransom et al., 2008).  For instance, a company may be having trouble with understaffing, yet has a tight budget. The plan for improvement would be deciding on who, what, when, and where the problem can be fixed. Essentially, in the given scenario, it would be the planning of who, what, when, and where the organization can procure a sufficient amount of staff, without going over budget.

The second step is to do what has been planned, also known as the implementation phase of the improvement (Arveson, 1998). After addressing the expectations of the plan, it is time to take the appropriate actions that will help in the accomplishment of the organization’s mission. For understaffing, and a tight budget, the plan may be to analyze records showing the average peak times of service and subsequently hiring a part-time employee for those times of the day.

Along with implementing the plan, it is important to measure the plans’ success with valid and reliable tools; this is to ensure that the improvement is, in fact, improving.  Using a mix of tools, such as patient satisfaction surveys and budget reports, a company can verify the usefulness of the extra employee, the efficiency of the plan and compare the results with past and/or current situations. Ransom et al. (2008) suggests using valid and reliable measures to ensure consistency in results such as the Consumer Assessment of Healthcare Providers and Systems initiative (CAHPS).  This program is designed to assess the degree to which care is patient-centered, compare and report organizational performance and improve quality of care.

The third step of the improvement is to check your results, also known as the assessment step (Arveson, 1998). The analyzing of results is a process that includes summarizing what was learned from them (Ransom et al., 2008). The summary’s importance is to aid in determining which direction to take for the fourth, and final step, of the cycle (Tague, 2004). In the scenario given, the results will hopefully help to determine if the extra employee is worth the addition to the organization and/or and worth the addition to the payroll. If the role of assessing results is placed upon an individual or individuals, who are not parts of the management team, the final action in this step is to report the results to those who are in the decision-making role.

Last in the cycle is to take action. If it worked, great, if not, further actions to get to the organizations goal should be taken.  It is important to use what was learned from the assessment phase, to make modifications to the current plan, or to change the plan altogether (Ransom et al., 2008). Either way, the idea of the cycle, is to carry out additional cycles until the organization’s goals are met.

Essentially, the PDCA Cycle can be considered a basic method for improving organizational processes.  The continued use of the model is encouraged to get an organization to its end goals and to maintain that position.  As the PDCA Cycle is a basis for most current models of improvement, it can be considered a reliable method for an organizations pursuit of quality improvement.

References:

Arveson, P. (1998). The Deming cycle. Balanced Scorecard Institute. Retrieved July 19, 2012, from http://www.balancedscorecard.org/thedemingcycle/tabid/112/default.aspx

Ransom, E. R., Joshi, M. S., Nash, D. B., Ransom, S. B. (2008). The Healthcare Quality Book (2^nd ed.). Chicago, IL: Health Administration Press.

Tague, N. R. (2004). Plan-do-check-act (PDCA) cycle. The Quality Toolbox (2^nd ed.). (pp. 390-392). ASQ Quality Press. Retrieved July 19, 2012, from http://asq.org/learn-about-quality/project-planning-tools/overview/pdca-cycle.html