INDUSTRIAL ENGINEERING APPLICATIONS IN HEALTH CARE SYSTEMS:APPLICATION OF QUALITY-IMPROVEMENT TOOLS

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APPLICATION OF QUALITY-IMPROVEMENT TOOLS

The concepts of quality control, quality improvement, and quality management in the United States largely evolved from the efforts of Dr. W. Edward Deming, Dr. Joseph Juran, and Philip Crosby. Manufacturing industries were first to apply these concepts to achieve significant improvements in the quality of manufactured goods while reducing costs. During the late 1980s, the health care industry started using some of these methods to improve quality of health care delivery and reduce costs. Many hospitals started continuous quality improvement (CQI) and total quality management (TQM) programs. Sahney et al. (1989) summarize 10 common points from the quality philosophies of Deming, Juran, and Crosby and conclude that they can be applied to any industry, including the health care industry, to improve quality.

Continuous quality improvement focuses on improvement of various processes in a health care organization. It starts with identifying the customers and their needs for each of the processes. The objective is to improve the processes to meet the needs of the customers. All the changes are data driven. Key quality characteristics are identified and measured to track improvements. The physicians and hospital employees are trained in quality concepts and tools for improvement. Some of these tools are the Pareto chart, the cause–effect (or fishbone) diagram, flowcharts, run charts, and control charts. These tools assist in the documentation, analysis, and improvement of processes. Sahney and Warden (1991), and Gaucher and Coffey (1993) give a good overview of the application of CQI approach in health care. A popular CQI methodology is FOCUS-PDCA. Griffith et al. (1995) give a description of this methodology.

Another term in the quality improvement effort that has gained popularity during the late 1990s is process reengineering. While the CQI approach looks at making incremental improvements in the processes, reengineering efforts look at radical redesign of systems and processes to achieve major improvements in the cost and quality of services (Hammer and Champy 1995). Kralovec (1993) provides a good introduction to applying reengineering techniques to health care. The proceedings of the Quest for Quality and Productivity in Health Services Conferences that have been held each year since 1989 provide numerous examples of the application of total quality management, CQI, and reengineering methods in health care systems.

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