There are many names that became famous and shone in the field of quality, whether in the industry or in the health sector, in addition to many bodies and organizations that had a lot of experiences and models regarding quality and its programs and how to apply it. Among these names that became famous, the scientist Joseph Juran, the spiritual father of quality, appears to us. Edward Deming, Philip Crosby, Walter Schuhart, Donna Bedian Among the institutions that are known for their interest in the quality movement in health care are the Joint Commission on Accreditation of Healthcare Institutions “JCAHO”, the National Authority for Accreditation and Health Development in France ANAES, and the Canadian Accreditation Commission.
Several models have been proposed that directly contribute and assist in the application of quality management systems in health facilities and service alike. Below, some of the most famous models will be shed light, and through them we can know the similarities between these models and the most prominent differences between them.
First: Joseph Juran
Juran graduated from the University of Minnesota in 1924 AD and joined New York University and worked there as a university professor. At the same time, he worked in the Inspection and Inspection Department of the Hawthorne Western Electric Company, and that was until the beginning of World War II. Then he visited Japan and worked with many Japanese scientists and was able to provide a service to Japan that lies in Helping them to adapt to the ideas of quality and using statistical methods that are designed to implement the quality system.
Juran is considered one of the first pioneers of quality, as he authored many books, scientific articles, and publications that talk about quality, the most important of which is his book, which talks about quality control Handbook in 1951 AD, then in 1979 AD he established and established an institute specialized in quality management, which he called ” Juran Institute.
He also worked on developing a model that helps implement the quality system in the establishments and called it the “Juran Quality Trilogy”. Previously used in managing and planning the financial aspects, controlling and improving them, then Juran developed and applied them to the quality system.
It becomes clear to us that Juran sees quality from two angles, the first is an attempt to reduce error rates, the second is an attempt to improve the product in terms of form and content, and in order to achieve the needs and expectations of workers. In Juran’s opinion, paying attention to these two angles will help achieve many goals, including:
1- Increase customer satisfaction.
2- Increasing competition between establishments.
3- Low error rates.
4- Low loss rates.
He also believes that in the quality planning stage, which is the first stage of his tripartite or model that helps in applying quality, the focus is on setting the future goals of the facility, and then identifying the various resources available to the enterprise, whether material or human, and then trying to determine the needs and expectations of customers or beneficiaries of the service. The introduction and development of the quality of the product or service in accordance with the requirements of customers, and finally shed light on the steps of the production process and identify them in a way that ensures the proper workflow that helps increase the process of improvement and development.
As for the second phase of the tripartite, which talks about quality control or control, he believes that the processes or procedures that need improvement are identified, and then a measurement mechanism is set up. Finally, take the necessary corrective measures to control the process in case of any error.
In the third stage, which is the stage of quality improvement, mechanisms and procedures are put in place, which helps to achieve quality on an ongoing basis, and this includes distributing tasks to individuals in proportion to their capabilities, assigning individuals to follow up on quality projects and programs related to them, training workers on these systems and programs, and then forming a team His first task is to continuously follow up the quality improvement processes in order to maintain the gains, changes and improvements that have been achieved in the facility.
Juran summed up his thoughts on quality in ten points and called them “Juran’s philosophy of quality”, which are as follows:
1- Increasing the level of awareness among employees of the importance of improvement opportunities and identifying their needs.
2- Setting goals for the improvement process.
3- Paying attention to the organization process in order to achieve the desired goals, through the preparation of procedures. For example, a quality board can be formed to identify problems, select projects, appoint work team members, and appoint quality coordinators.
4- Paying attention to the training process, because the process of change cannot take place in a short time.
5- Paying attention to the implementation of projects that help the establishment in solving its problems.
6- Attention to submit periodic and comprehensive reports on the current status of the facility.
7- Encouraging employees and urging them to improve their performance by supporting them morally and praising them for the distinguished services they provide.
8- Focusing on the communication process between departments in the facility and paying attention to the feedback process as a means of communicating the results to the concerned departments.
9- Focusing on the importance of documenting the results and recording them in the form of a chart.
10_ Paying attention to the expansion process, by taking into account that the annual improvement is an important part of the facility system.
Finally, Juran believes that about 80% of quality defects are the result of several factors that the senior management is in control of. On this basis, Juran confirms that the senior management in any facility must pay attention to the process of continuous improvement of quality, through the application of his famous trilogy.
Second: Edward Deming
Edward was at the beginning of his working life a manufacturing engineer, and we know him through history that he was called the spiritual father of quality and its control, and despite his talk about ways to improve quality
Plainly and smoothly, however, it was ignored by the industrial leaders of America in the early 1940s.
In the fifties and sixties, after the industry leaders in Japan accepted Deming’s ideas about quality, most Japanese companies quickly adopted Deming’s principles of quality control, and employees became closely linked to work. Many awards were set up to be presented to facilities that improved and developed quality in them, as the award was established in 1962. Through the Japanese Federation of Scientists and Engineers, it was called the “Deming Award for Quality.” This award is considered one of the most important Japanese awards in the field of quality. Within twenty years, the reputation of Japanese products has changed and it has become a symbol of quality.
Quality, in Deming’s perspective, is “continuous reduction of losses and continuous improvement of work in all activities.” He talked about many aspects of management and how we improve their levels of performance. For him, management is responsible for understanding the merits of work and its system, coherence and stability of work procedures, and supporting the process of continuous improvement and development. By clarifying this idea and this perception in the fourteen principles that he developed in quality management, which are as follows:
1- Setting a firm goal for the establishment in order to improve the quality of its products and services.
2- Adopting a new philosophy of the concept of quality.
3- Stop relying on inspection for the purpose of improving quality, but it is preferable to use statistical methods to monitor scientific productivity.
4- Stop practicing the purchase philosophy that is based on prices only, and it is preferable that the financier “seller” enjoy the quality characteristic.
5- Using statistical methods to know the type of problems and their sources, as well as continuing to improve the system.
6- Using modern tools for on-the-job training.
7- Using modern methods in the supervision process.
8- Away from the policy of intimidation.
9 – Eliminate organizational obstacles between different departments.
10- Get rid of digital quotas.
11- Periodic review of work standards in order to achieve high quality.
12- Removing obstacles that stand in the way of pride in the quality of work.
13- Developing a strong program to train workers on new skills.
14- Take the necessary measures to achieve the transformation process by applying the contents of the aforementioned thirteen points.
Through the previous principles, Deming extracted seven very serious problems that hinder the process of improving and developing quality. These problems are:
1- Not specifying the objective of the establishment.
2- The establishment’s focus on short-term profits.
3- Focusing on the digital calendar of performance and annual rates.
4- The continuous change in the administrative leadership.
5- The establishment should be managed through known numbers.
6- The continuous rise in medical costs.
7- The continuous rise in commitment costs and bad debts.
From the point of view of the scientist Deming, quality must be the focal point of any facility through the adherence of the workforce by the management to the long-term perspective, and that it is the responsibility of the senior management to adopt the idea of developing policies and procedures and work to prepare its employees to accept change and continuous development and their awareness of their administrative and technical responsibilities.
He also focused on the relationship with suppliers to be based on quality and not on low prices, and pointed out the importance of continuous development in quality testing methods and more understanding of the needs and expectations of beneficiaries.
Finally, Deming stressed the importance of knowing the science of statistics, especially the simple statistical methods that help decision makers in taking the optimal path or path and identifying types of deviations during the production process, and he did not focus only on the system and its components, but also cared about the human aspect of the process as he urged management To know the ways that work to motivate workers and urge them to raise the level of work performance.
Third: Walter Shewhart
Shewhart worked as a statistician in New York State during the twenties and thirties, and in 1924 AD he developed a model for continuous improvement of the productive process. .
In 1931 AD, Schuhart authored the book “Economic Control over the Quality of Manufactured Products”, which is considered one of the best books that contributed to improving the quality of products and commodities.
Schuhart believes that the task of the quality controller lies in the process of maintaining a certain level of the production process and allowing some deviations that do not exceed the agreed control limits. We can review the most important operations that take place in each step of the Schwhart model:
The first step: planning
The planning stage is one of the most important pillars of the Schwhart department, and some quality tools are used to find out the problems that the facility faces and identify the quality of customers, and then agree on the level of production quality and thus help the management to carry out improvement and development processes in the best and continuous manner. Then identify the needs The customer and setting goals in line with these needs in order to reduce the gap between those needs and what is actually in the facility. The quality management department has to survey the opinions and impressions of customers in order to know their expectations.
Step two: action
In this step, many alternative solutions are proposed until the optimal solution is reached in order to implement the improvement process properly. The work team implements the plan on the basis of a number of serious attempts and monitors its results, provided that these attempts are made on a certain number of beneficiaries or customers, or that Focusing on a specific problem instead of distraction among a wide range of problems and trying to overcome this problem by implementing the plan that has been developed in advance. Then the work team sets a timetable for the process, and the resources and expenses that will be used in the process are clarified and estimated, with the need to train workers on how to switch from the current situation to the new one that serves the quality improvement process and its continuity.
Third step: examination
At this stage, the new situation that the establishment reached and what happened after the change process is identified, so data is collected and analyzed, and indicators and standards are used for comparison and measurement of the extent of change and the extent of improvement in the client.
This study helps decision makers to know the changes that have taken place and what activities have accompanied the process of change, are they positive or negative? In other words, this stage shows the extent to which the objectives that have been planned have been achieved.
Step four: act
Based on the statistical analyzes and the data collected, the work team uses the new improvements as a standard for future business and applies them to other operations, whether administrative or technical. With the continuation of this circle, the circle of improvements in the facility expands. In the event that no improvements appear, the work team tries again with the creation of Some modifications to the surrounding conditions.
Fourth: Philip Crosby
Crosby is considered one of the most famous pioneers of quality and its development methods, as he established a specialized college for quality, and in 1979, Crosby became more famous through his book Quality Is Free, where he began his working life when he joined the Crosby Company in Indiana, and after working in many jobs, Crosby became Director of Quality In the missile project, and through his work on this project, his thinking developed and focused his efforts on methods of developing and improving quality and reducing its costs.
He is considered the first to advocate the idea of “a defect-free industry.” Crosby confirms that this program does not mean that workers do not make mistakes, but rather that the facility should expect that workers will not make mistakes, and he believes that if a zero level of defects is not achieved, we will not be able to achieve this goal at all. .
The Crosby model consists of fourteen principles, which are as follows:
1- Unwavering commitment by the senior management.
2- Forming a team to improve quality.
3- Use measurement as an objective tool.
4. Determine the cost of quality.
5- Raising awareness of the importance of quality.
6- Take corrective action.
7-Proper planning to remove defects in the product.
8 – Focus on educating employees and training supervisors to play their role in improving quality.
9- Determine a special day to raise awareness of the importance of the slogan “Flawless Industry”.
10- Setting goals and encouraging individual innovation within the organization.
11 – Eliminate the causes of errors and remove obstacles to effective communication.
12- Recognizing the importance of the quality improvement process and rewarding those who make extraordinary efforts in developing and improving quality.
13- Formation of quality councils, one of whose tasks is to coordinate and communicate with the members of the quality development teams.
14-Continuing the quality improvement process, by repeating previous processes in order to give employees
Continuous encouragement to remove quality obstacles and achieve the objectives of the facility.
Through his previous principles, Crosby focused on four main axes, which he called the foundations, as follows:
1- Crosby defines quality as “conformity with basic requirements.” Crosby believes that the administrative and technical staff in the facility must comply with the provided commodity or service with the basic standards that have been set as one of the essential requirements to improve the level of performance.
2- The quality system For suppliers who are trying to meet customer requirements and meet their needs, it is the correct implementation of quality requirements the first time they try to meet those requirements. And Crosby confirms that the establishment that adheres to this principle will have a small number of observers, because then each individual will be responsible for his work, and there will be no one to monitor him or catch mistakes for him.
3- Standard performance achieves a level of zero defects and errors. Crosby has rarely said that the idea of a flawless product may be a primary or final goal. Therefore, we can say that excellence in performance is the level free of defects.
4- The measure of quality is the cost of quality itself. The cost of a defect or error, if it is repaired, has a direct positive impact on the final performance as well as on the customer relationship. Therefore, there must be exercises that help avoid these errors.
Finally, we find that Crosby urges the importance of measuring the cost of non-conformity instead of focusing on the traditional concept of measuring indicators, so Crosby relies on the best measure of quality is its cost.