Quality
Circles and Feedback Loops
What are they and how are they used to strengthen quality
management?
Quality circles and feedback loops are curriculums that
are composed of employees or consumers that aid companies and healthcare
organizations in arbitrating, analyzing, and solving work-related issues,
presenting the solution to supervisors, and implementing the solutions
themselves to improve performance in health care organizations. Discovering
knowledge through analysis, ideas will be brought together on how to strengthen
quality management initiatives and activities.
Quality Circles
According to Savane, (2012),
quality circles were originated in the 1950’s in the United States, it is
stated that this gives employees the ability to provide contribution into the
organization they work in irrespective of their position within the company. In
addition to that, quality circles were originally linked with Japanese
management and manufacturing techniques. The introduction of quality circles in
Japan was inspired by lectures from Edward Deming (1900-1993), a statistician
for the United States government.
On the other hand, a study was performed by Saleh, Guo,and Hull(1990)discovered that after sending out questionnaires to a number of
auto companies inquiring about their use of quality circles and feedback
groups, a response was given. The response was that quality improvement and
organizational effectiveness supported the value of their company. Even though
this article was written over a decade ago, quality circles are still dominant
as much today as back then.
Quality circles groups were also known by descriptions
such as suggestion boxes. Employees were able to give written suggestions
regarding problems or changes they believed was needed within the organization.
Also,problems are identified by members themselves by using brainstorming as a
technique and at the request of management and other departments. Once quality
circles resolve the problem related to quality, cost reduction, safety, other
areas increase. Quality circles improve the quality of life and have a positive
impact on employee attitudes and team culture (Savane, 2012) .
Ways to Implement Quality Circles
Initially, management are the first ones informed about
the quality control process being planned.
- Committees are developed and key individuals like a coordinated –in-house coach are designated
- The opportunity is well-defined and areas of application are recognized
- First-line administrators in the designated areas are given QCC demonstrations
- This followed by intensive training for middle management and directors on the process and their roles
- Employees have the opportunity to become a member of a circle, they are trained once they become part of the circle
- Problems are deliberated and resolved in a systematic method
in the QCC’s. It is important that solutions are executed swiftly to maintain
momentum
However, feedback loops play a significant role in quality
management as well.
Feedback Loops
Mainly feedback groups consist of people, but this
specific feedback group is an automated interactive voice response system. This
system is designed to initiate a phone conversation with a patient with the
patient’s permission, and inquire about the visit to the healthcare
organization they visited. Using this process allows the healthcare
organization to have feedback and are then able to compile and offer a better
value for patient satisfaction. Unfortunately, this process does contribute to
some of its own issues. Time delays in the information that is submitted to the
clinician can cause a problem because the information is only sent twice a day.
Hence, certain interactive measures are cut short by using this method (James, Krawitz, & Berner, 2013)
On the other hand, Cahill, (2013), specifies that the
purpose of feedback loops groups are to boost positive feedback within a
particular process or group. The demonstration speaks to the healthcare arena
in the area of hand washing, going from sanitary to unsanitary, and how to
increase occurrences that can be better understood and developed by everyone.
Cahill chose a sympathetic feedback group where individuals are able to pair
with each other to give positive attributes of quality improvements. Also,
individuals can find ways to achieve the goal of quality attainment in what is
called real time. She signifies that this type of project reveals a
relationship or partnership with commitment, and Cahill has the belief that
nurses have the ability to change the healthcare culture one individual at a
time (Cahill, 2013).
Conversely, other individuals had a different perspective
on the role of feedback. According to (Hattie & Timperley, 2007), their
review discussed how feedback is one of the most powerful influences on
learning and achievement. However, this impact can be either positive or
negative. Depending on how an individual interprets feedback and how it is
given can be very different depending on the type of organization that uses the
feedback loop group.
Nevertheless, this article focuses on education where the
basic potential for the purpose for the feedback group are fundamentally the
same as the feedback group for healthcare. According to the article, the
meaning of feedback is to hypothesize information from a go-between or agent to
an individual’s demonstration and understanding coming into focus. Being that a
feedback group consist of at least two individuals, it is possible to transfer
information from one to another. It is also believed that is a consequence of
performance and there is difference between feedback and instruction. However,
when the two are combined they become one in how are they work. This process
needs to provide information relating to the learning process of what is
understood and what is meant to be understood (Hattie & Timperly, 2007).
Ways to strengthen quality management
There are three ways quality
circles and feedback loops can be used within healthcare organizations to strengthen
quality management. The first way is Plan, Do, Check, Act (PDCA), which works
to close the loop on quality circles and strengthen quality management. This particular
process begins identifying an area of development, ask individuals that do the
work to note how the process flows presently, collect data on the current
process such timing each phase of the process, discuss improvement suggestions,
implement the suggestions in the process, check how the process is working with
new elements in place, document any areas of weaknesses that hinder improvement,
then decide if there is a next step (Berwick, 1996) .
Berwick, 1996, informs us that “it is critical
at the studying stages of PCDA cycle to take time to reflect and learn about
other improvements that have already been made.” This can take several months
to gather accurate data. Once the new process is in place, the job has just
begun. There are measures that are looked into daily, weekly, and even monthly
to ensure that results are at the new standard. This type of quality assurance
is an awesome way for organizations to see the bottom line as it relates to
cutting cost and savings. The process should be changed and individuals
involved in the process are needed to identify how to deal with an issue, this
allows them to become part of the resolution (Sollecito & Johnson, 2013) .
Another way to strengthen
quality management is use Standard Work & Audits. Standard Works is created
by following an individual who performs a particular process and recording the
hard starts and stops during the process. The hard starts and stops makes
timing the pieces easier. An example would be to time an individual doing a
task. The timer would start once the person begins the task, and the timer
would stop once the task is completed. This same process applies to health care (Berwick,
1996) .
The purpose of standard work
is to create one way of doing a process. This ensures safety, quality, and all
the steps of the process are completed. With fewer variations, managers can be
sure on answers. Reducing variation in the process, increases certainty and
performance results are predicted (Sollecito & Johnson, 2013) . Standard work has
timing associated with it as well. Timing allows for a measurement of how many
times a process can be repeated in a certain time frame. For instance, it takes
10 minutes to take a patient from the check in point of the ER, until the physician
walks in. Therefore, six patients should be seen an hour. Then this information
is taken to the next level to ensure that the proper amount of staff are
working to reach this goal.
Standard work also comes
with audits. The last loop of determining if the process is working is to have
a staff member shadow team members and time the steps of how they perform the
process. This is a great method to audit, the steps are recorded and the
timings lets an individual know at what pace the team member should be working.
Standard work is an ongoing process that allows an individual to assess quality
and have a baseline to begin with. Therefore, goals that need to be met can
change according to the needs of the department.
The last method to improve
quality management is A3 problem solving. A3 begins with identifying a problem,
once the problem is defined breaking down that issue by searching for the root
cause, use the 5 why’s to reach the reason why the problem is occurring. The 5 whys
are the reason behind the initial problem. In most cases, they drive the answer
to being resolved. A3 is about setting a standard, showing what happens before
and after the process. This quality loop usually has a significant development through
the changes made. This type of quality measure is time consuming. Data collection
and problem solving takes a lengthy amount of time. It is crucial to get
accurate and complete information when collecting data (Berwick,
1996) .
Cost and Managed Care
Because of the rising health cost, patients are really
concerned about how they can afford health care. Programs such as the
Affordable Healthcare Act sole purpose was to build a report with patients and
assure their safety through health care. Unfortunately, it has created a change
in the pay ability for services and reduces the opportunity for patients to
have important procedures completed (Kaplan & Porter, 2011) .
Health care spending is
rising and being measured incorrectly. In 2011, health care spending used about
seventeen percent of the national gross Domestic Product and it continues to increase.
Instead of looking at the cost of care for a specific procedure, the healthcare arena has appraised the cost of specialty or departmental cost of a
patient’s procedure. In addition to that, improper billing and payments of a
patient’s procedural cost misrepresents the expertise of care (Kaplan &
Porter, 2011) .
Having value is a goal for the healthcare arena. In
order to achieve this goal, an individual has to properly measure the value in
outcomes and cost at the patient level. Medical outcomes should be measured
along multiple dimensions from survival to recovery. Another part of value is
the measures of cost for delivery of these outcomes. However, a more balanced
method for dealing with healthcare cost is the greatest obstacle that the U.S. has in order for the economic status not to collapse completely. Health care cost
has become a burden to Americans today (Kaplan & Porter, 2011) .
Conclusion
Quality circles and feedback loops are used in the healthcare arena to help solve work-related issues. Even though they consist of small
groups they serve the purpose of improving quality management within healthcare organizations. In addition to that, these methods can also help with cost
and managed care if used properly.
References
Berwick, D. (1996). A primer on leading the
improvement of systems. Institute for Healthcare Improvement.
Hattie, J., & H, T. (2007). The power of feedback. American Nurse
Today, 81-113.
James, W., Krawitz, M., & Berner, E. (2013). Closing the feedback
loop: An interactive voice response. Journal of Medical systems, 1-10.
Kaplan, R. S., & Porter, M. E. (2011). How to solve the cost crisis in
health care. Harvard Business Review, 46-64.
S, C. (2013). Thoughtful feedback loop: A nurse's approach to personal and
organization improvement. American Nurse Today.
Saleh, S., Guo, Z., & T, H. (1990). The use of quality circles in the
automobile parts industry. Engineering Management, 198-202.
Savane, A. (2012, April 6). Final Quality. Retrieved from Final
Quality Circle: www.slidehare.net
Sollecito, W. A., & Johnson, J. K. (2013). Continuous Quality
Improvement in Health care. Burlington: Jones and Bartlett Learning.
