The Quality Improvement Paradigm in Health:
Quality Improvement methods have been developed by American and Japanese engineers since before
World War II and are part of all the most successful world class businesses, most famously in manufacturing and design, and also in all kinds of organizations including hospitals and schools. The role of W.E. Deming was especially important as an inspiration to many. Deming's 1986 book had the bold, audacious and commanding title, "Out of the Crisis."
Quality improvement methods are the application of scientific methods to practical problems within a new theoretical framework, systems thinking, backed by a new kind of statistics. The complete quality package of Quality includes tools, processes, and a different view of the world in general. Quality improvement takes the scientific revolution to another level in both theory and practice.
Quality improvement methods are known as Six Sigma and Total Quality.
Quality has two meanings:
Quality #1: Results for customers, clients, or patients, not just what they want but what they need in terms of total value, which includes costs.
Quality #2 Preventing Problems from the design of the solution by the health care practitioner to the accuracy of the individual health seeker’s implementation of the solution. This is called quality control or quality assurance, QA, and is based on prevention instead of inspection after the fact.
QUALITY #1 Results for Customers
Customer Focused Health
The customer means the human being and their needs: client, patient, etc.
This differs from health care driven by a specialist technique: hammers seeking nails.
Customer focused health aims at “complete solutions,” keeping track of all needs so the client can get the final result of optimum health. Complete solutions can be pursued through the service delivery strategy of health coaching, with the coach acting as a generalist: nutritionist, guide to do-it-yourself physical therapies, shopping consultant, etc, while referring out to specialists like orthodontists as needed.
Complete Solutions was created by the computer company IBM as it transformed itself into an information company to align its mission with customers needs: all their information needs, not just the hardware. IBM continued to make computers but would recommend another brand of hardware if necessary to service the client’s interests best.
Customer Driven Innovation
Customer needs are best understood by people who have been through the healing of health problems that customers want solved. It’s very difficult for anyone who has not been through chronic fatigue to know what that is like and how individualized solutions are. Only people who are highly sensitive to commonly recommended supplements that are “scientifically proven” understand. The new science of quality improvement is a method to figure out N=1: fully customized solutions
Deeper understanding of customer needs inspires innovation in solutions. Difficult problems require creativity. In fact, chronic illnesses now require a revolution in paradigms beyond the medical model with its fragmented version of science, and toward a holistic model focused on lifestyle and environment of the health seeker. A holistic model of health favors a more complex approach beyond specialists in favor of holistic generalists like health coaches.
The medical model defines health problems in terms of the expert’s specialty and sometimes even for their convenience: solutions are take it or leave. The health seeker is alone in fragmented shopping experience subject to emotional appeals of marketers and not being held accountable to implementation with no checks on self-sabotage.
The holistic model with its service delivery model of coaching aims at complex customized solutions with support for the messy details of implementation and complexity. Coaching shifts health seeking from a shopping transaction to an internal transformation.
QUALITY #2 Preventing Problems
Prevention versus Inspection after the Fact
In manufacturing and services the aim is to prevent problems like defects and delays because this saves time from fixing things after that fact, and save materials that would be wasted. Quality improvement lowers costs, time, and waste. Quality improvement is synergistic thinking, not trade-off thinking.
A health problem is a “defect” in the quality of life.
The medical system addresses health problems after they occur, and usually only the symptoms, like an inspection system in a factory.
Preventive health focuses on the lifestyle and environment in which root causes reside.
The total in total quality means the total organization or culture is responsible:
Each individual is responsible for quality of health on a preventive level and to improve health.
- In a factory it is not just quality inspectors but all employees in their work preventing defects and improving processes to be more reliable or designs to be more value added and durable.
- In health it is not just doctors acting as inspectors catching and fixing problem when it is too late, but each individual changing their lifestyle.
- For people in general it is taking responsibility for the environment: what we each produce and consume that may be toxic and affecting others. It is important to add environment so that “lifestyle” is not a way of blaming individuals in isolation.
Six Sigma is a statistical term for 3.4 parts per million defects / mistakes in manufacturing, a very low rate of defects to strive toward.)
The next page explains the conceptual foundation of quality improvement: a theory of systems: body, mind and environment are systems. This is holistic thinking.