TQM Statistical Tools
TQM Statistical Tools
Here follows a brief description of the basic set of Total Quality Management tools. They
are:
Pareto Principle
Scatter Plots
Control Charts
Flow Charts
Cause and Effect , Fishbone, Ishikawa Diagram
Histogram or Bar Graph
Check Lists
Check Sheets
Pareto Principle
The Pareto principle suggests that most effects come from relatively few causes. In
quantitative terms: 80% of the problems come from 20% of the causes (machines, raw
materials, operators etc.); 80% of the wealth is owned by 20% of the people etc. Therefore
effort aimed at the right 20% can solve 80% of the problems. Double (back to back)
Pareto charts can be used to compare 'before and after' situations. General use, to decide
where to apply initial effort for maximum effect.
Scatter Plots
A scatter plot is effectively a line graph with no line - i.e. the point intersections between
the two data sets are plotted but no attempt is made to physically draw a line. The Y axis is
conventionally used for the characteristic whose behaviour we would like to predict. Use,
to define the area of relationship between two variables.
Warning: There may appear to be a relationship on the plot when in reality there is none,
or both variables actually relate independently to a third variable.
Control Charts
Control charts are a method of Statistical Process Control, SPC. (Control system for
production processes). They enable the control of distribution of variation rather than
attempting to control each individual variation. Upper and lower control and tolerance
limits are calculated for a process and sampled measures are regularly plotted about a
central line between the two sets of limits. The plotted line corresponds to the
stability/trend of the process. Action can be taken based on trend rather than on individual
variation. This prevents over-correction/compensation for random variation, which would
lead to many rejects.
Flow Charts
Pictures, symbols or text coupled with lines, arrows on lines show direction of flow.
Enables modelling of processes; problems/opportunities and decision points etc. Develops
a common understanding of a process by those involved. No particular standardisation of
symbology, so communication to a different audience may require considerable time and
explanation.
The cause-and-effect diagram is a method for analysing process dispersion. The diagram's
purpose is to relate causes and effects. Three basic types: Dispersion analysis, Process
classification and cause enumeration. Effect = problem to be resolved, opportunity to be
grasped, result to be achieved. Excellent for capturing team brainstorming output and for
filling in from the 'wide picture'. Helps organise and relate factors, providing a sequential
view. Deals with time direction but not quantity. Can become very complex. Can be
difficult to identify or demonstrate interrelationships.
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A histogram is a graph in which the continuous variable is clustered into categories and
the value of each cluster is plotted to give a series of bars as above. The above example
reveals the skewed distribution of a set of product measurements that remain nevertheless
within specified limits. Without using some form of graphic this kind of problem can be
difficult to analyse, recognise or identify.
Check Sheets
A Check Sheet is a data recording form that has been designed to readily interpret results
from the form itself. It needs to be designed for the specific data it is to gather. Used for
the collection of quantitative or qualitative repetitive data. Adaptable to different data
gathering situations. Minimal interpretation of results required. Easy and quick to use. No
control for various forms of bias - exclusion, interaction, perception, operational, non-
response, estimation.
Check Lists
A Checklist contains items that are important or relevant to a specific issue or situation.
Checklists are used under operational conditions to ensure that all important steps or
actions have been taken. Their primary purpose is for guiding operations, not for
collecting data. Generally used to check that all aspects of a situation have been taken into
account before action or decision making. Simple, effective.
TOOLS OF TOTAL QUALITY MANAGEMENT
Sujata Mitra
Implementing TQM in the hospital
posed certain challenges. It meant convincing
people that Quality was not extra work, it was
an integral part of work and the way to work.
People had to be motivated to achieve ‘gobeyond-
service’ Quality. The approach was to
encourage people to be creative and find
solutions to their own problems.
Which brings us to the next stumbling
block. Would all the individual efforts combine
to give a significant thrust to the Quality
movement or would they remain isolated
islands of improvement? There was need to
align and prioritise the individual goals with
the organisational goals, conversely, the
organisational goals had to cascade down to
individual goals. Specialised training in IVF
technique could be an individual need, but if
the organisational goal was to reduce average
hospital stay, laparoscopic training would be
given priority.
Prioritisation and alignment was done
through the Balanced Scorecard concept.
1. BALACED SCORECARD
This is a set of measurements and
targets that are used to prioritise and quantify
goals (Ref.Chow,et.al,1998). A hospital may
have identified cost competitiveness as its goal.
How is this communicated to all the working
units? In the scorecard, an overall target for
cost saving is set which is then broken into
specific targets for different areas like power
consumption, rightsizing, revenue generation
etc. Each department sets its own target in
these specific areas and plans to achieve it
through improvement projects, value
engineering etc. Ultimately, two and two may
not just be four, but even five due to this
synergistic working.
The scorecard is like a progress report.
It is a ready reckoner for planning as well as
assessing progress vis.a.vis the targets (Ref.
Fig. 2, ‘An introduction to TBEM model’).
II. QUALITY IMPROVEMENT
PROJECT
A quality improvement project is taken
up preferably by a cross-functional team to
tackle chronic, recurrent problems which
impact upon customer satisfaction (Ref. Total
Quality Handbook, Tata Steel). Most of these
problems are either not obvious or have been
swept under the carpet. The job of the team
lies in correctly identifying the problem,
analysing it and coming up with a solution that is
acceptable to all. If it is a problem that cuts
across different work areas, a cross functional
team ensures that benefits are shared by all.
A number of patient complaints related
to long waiting time in the out-patient
department. One of the hospital goals
therefore, was to reduce average waiting time in
OPD to less than 30 minutes. The Cardiology
department took up the challenge and included
this as their departmental goal. A QIP team
was formed. After data collection and
brainstorming for all possible causes, the main
reason identified for the increased waiting time
was too many patients arriving at the same
time. The analogy of congestive cardiac failure
was drawn- increase in preload (number of
patients) leading to pump failure (doctors
unable to cope with the sudden rush). The
solution was again drawn from the analogyreduce
the preload! An appointment system
was put in place, with segregated time slots
for different patient categories. The solution
appealed to both, doctors and patients, and the
pump efficiency increased to 90% patients seen
within 30 minutes! (Ref.Bharat et.al, 1999). This
solution has been emulated by other clinical
departments too so that today the average
waiting time in OPDs is less than 15 minutes
and more than 95% patients are dealt with in
less than half hour of their arrival.
III. VALUE ENGINEERING PROJECT
Cost effectiveness is the need of the hour
for any organisation. A value engineering
project helps to achieve this
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strategic goal. It aims at ‘Value added service’.
It implies reducing wastage, not spending.
Teams use creativity and innovation to come
up with alternatives that may be cheaper,
eliminate wastage or add value to existing
services (Ref. Jaganathan, 1998).
A classic example is the value
engineering done in the Nursery to reduce
wastage of nappies. Irrespective of baby size
or need, bulky, full size nappies were provided to
all babies, which, besides wastage, were quite
uncomfortable for the little customers. Nurses
and doctors brainstormed to find out what the
ideal nappy size should be. The existing nappies
were reduced to a quarter, wastage was
eliminated and the babies smiled!
IV. QUALITY CIRCLE
A Quality Circle is a small group of
employees from the same work area who
voluntarily meet regularly to identify, analyse
and resolve work related problems (Ref.
Hutchins, ‘In pursuit of Quality’ 1990) This not
only improves the performance of any
organisation, it also motivates and enriches the
work life of employees. The philosophy behind
Quality Circles is building people.
A Quality Circle tackles small, work
related problems through teamwork.
Statistical tools are used to analyse problems,
members arrive at a solution by consensus and
implement it themselves. This leads to
empowerment at the grass root level.
TMH has 57 active Quality Circles in
diverse work areas like the Hospital laundry
and kitchen, Steward section, Nursing section
etc.
Unlike the QIP and VE teams, a Quality
Circle is permanent.
The quality circle of the hospital kitchen
was worried about the complaints regarding
the quality of food. The chappatis in particular,
were singled out for criticism. The fluffy, soft
chappatis leaving the kitchen became cold and
hard by the time they reached the patients. The
defect lay in the distribution system. A simple,
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but innovative solution was rearranging the
food on the trolleys. The chappatis were now
wrapped in a cloth and placed directly on top
of the steaming ‘dal’container.
Patient satisfaction on hospital services
is greatly influenced by mundane matters like
food. If professional expertise is not backed
with concern in areas like hospitality, patient
dissatisfaction is bound to linger. With
successful quality circles taking care of such
‘pinpricks’, the hospital administration can rest
easy.
V. INTEGRATION OF
IMPROVEMENT INITIATIVES
How do these improvement initiatives
contribute to improving the overall
performance of the hospital? As described, all
targets cascade from the scorecard. The
integration of improvement projects with the
scorecard is shown in Fig.l
REFERENCES
1. Bharat.V., Mohanty.B., Das.N.K,
‘Waiting time reduction in out patient
services -an analogy to heart failure
therapy.’ Indian Journal of Occupational
and Environmental Medicine; 1999; 3,
181-184
2. Chow.W.Chee, ‘The balanced scorecard: A
potent tool for energizing and focusing
healthcare organisation management’-
Journal of HealthcareManagement 43:3
May/June 1998
3. Hutchins David ‘In pursuit of Quality’
Wheeler Publishing, 1992
4. Jaganathan.G. ‘Getting more at less cost-
The value engineering way.’ Tata McGraw
Hill, New Delhi,1992
5. Total Quality Handbook, Tata Steel