PDCA

Abstract: With the rapid expansion of knowledge and technology and a health care system that performs far below acceptable levels for ensuring patient safety and needs, front-line health care professionals must understand the basics of quality improvement methodologies and terminology. The goals of this review are to provide clinicians with sufficient information to understand the fundamentals of quality improvement, provide a starting point for improvement projects, and stimulate further inquiry into the quality improvement methodologies currently being used in health care. Key quality improvement concepts and methodologies, including plan-do-study-act, six-sigma, and lean strategies, are discussed, and the differences between quality improvement and quality-of-care research are explored.

Abstract: Purpose: of this paper is to introduce the reader to the characteristics of PDCA tool and Six Sigma (DMAIC, DFSS) techniques and EFQM Excellence Model (RADAR matrix), which are possible to use for the continuous quality improvement of products, processes and services in organizations. Design/methodology/approach: We compared the main characteristics of the presented methodologies aiming to show the main prerequisites, differences, strengths and limits in their application. Findings: Depending on the purpose every organization will have to find a proper way and a combination of methodologies in its implementation process. The PDCA cycle is a well known fundamental concept of continuous-improvement processes, RADAR matrix provides a structured approach assessing the organizational performance, DMAIC is a systematic, and fact based approach providing framework of results-oriented project management, DFSS is a systematic approach to new products or processes design focusing on prevent activities. Research limitations/implications: This paper provides general information and observations on four presented methodologies. Further research could be done towards more detailed study of characteristics and positive effects of these methodologies. Practical implications: The paper presents condensed presentation of main characteristics, strengths and limitations of presented methodologies. Our findings could be used as solid information for management decisions about the introduction of various quality programmes. Originality/value: We compared four methodologies and showed their main characteristics and differences. We showed that some methodologies are more simple and therefore easily to understand and introduce (e.g. PDCA cycle). On the contrary Six Sigma and EFQM Excellence model are more complex and demanding methodologies and therefore need more time and resources for their proper implementation.

Abstract: Background: The demand for the highest-quality patient care coupled with pressure on funding has led to the increasing use of quality improvement (QI) methodologies from the manufacturing industry. The aim of this systematic review was to identify and evaluate the application and effectiveness of these QI methodologies to the field of surgery. Methods: MEDLINE, the Cochrane Database, Allied and Complementary Medicine Database, British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, Embase, Health Business™ Elite, the Health Management Information Consortium and PsycINFO® were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Empirical studies were included that implemented a described QI methodology to surgical care and analysed a named outcome statistically. Results: Some 34 of 1595 articles identified met the inclusion criteria after consensus from two independent investigators. Nine studies described continuous quality improvement (CQI), five Six Sigma, five total quality management (TQM), five plan-do-study-act (PDSA) or plan-do-check-act (PDCA) cycles, five statistical process control (SPC) or statistical quality control (SQC), four Lean and one Lean Six Sigma; 20 of the studies were undertaken in the USA. The most common aims were to reduce complications or improve outcomes (11), to reduce infection (7), and to reduce theatre delays (7). There was one randomized controlled trial. Conclusion: QI methodologies from industry can have significant effects on improving surgical care, from reducing infection rates to increasing operating room efficiency. The evidence is generally of suboptimal quality, and rigorous randomized multicentre studies are needed to bring evidence-based management into the same league as evidence-based medicine. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.