Total Quality Management - Spring 2010 1

 At the end of this lecture, the student should

be able to:
1. Define the quality, quality control, quality assurance and total
quality management.
2. Identify the dimensions of quality.
3. Demonstrate continuous quality improvement cycle.
4. Differentiate between continuous improvement and traditional
improvement.
5. Demonestrate the quality chain.
6. Define total quality management (TQM).
7. Identify the goals of TQM.
8. Differentiate between two types of customers.
Introduction

Carrying out interventions correctly according

to pre-established standards and procedures,
with an aim of satisfying the customers of the
health system and maximizing results without
generating health risks or unnecessary costs.
What is Quality?

Total Quality Management - Spring 2010 4

Definitions of quality
 The Oxford English Dictionary (1988) defined
quality as “the degree or grade of
excellence”.

 Agency for health care research and quality

defind quality as “"the degree to which
health care services for individuals and
populations increase the likelihood of
desired health outcomes( services)."
Definitions of quality
 National Association of Quality Assurance
Professionals described quality as “the level of
excellence produced and documented in the process of
patient care, based on the best knowledge and skills
available and achievable at a particular facility.”

 American Society of Quality Control (ASQC) and American

National Standard Institute (ANSI) defined
 Quality is totality of features and characteristics of
product (goods and services) that bears on its ability
to satisfy given needs”
Dimensions of Quality
 Technical competence
 Access to service
 Effectiveness
 Efficiency
 Amenities
 Interpersonal relations
 Continuity
 Safety
Evolution of Quality Management

Company
Total Quality wide Quality
Control Control
Quality
Assurance

Quality
Control
(Acceptance
Sampling)
Mass
Inspection

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Evolution of Quality Management

 Mass Inspection  Quality Assurance

 Inspecting  Emphasis on prevention
 Sorting  Proactive approach
 Grading  Advance quality planning
 Rejecting
 Total Quality Control
 Quality Control  All aspects of quality of inputs /
 Quality Standards/ process and output
criteria
 Product/ service testing

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 Quality Management Evolution

Incorporates QC/QA activities into

Proactive Total Quality a company-wide system aimed at
satisfying the customer.
Approach Management
Prevention 4 (involves all organizational
Stop defects at source. functions)

Zero defects
Quality Planned and systematic actions to
Assurance insure that products or services
3
conform to company requirements

Reactive Operational techniques to

Quality make inspection more
Approach
Detection 2 Control efficient & to reduce the costs
of quality. (example: SPC)
Finding & Fixing
mistakes

1
Inspection Inspect products
Total Quality Management - Spring 2010 10
 The Acceptance Inspection Model

Process

Acceptance Inspection
Sampling

NO
Pass the Inspection?

YES

Acceptance
Reject,, Rework, Repair

Next Process
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 Quality Control

 Quality Control (QC) - “the operational

techniques and activities that are used to fulfil
requirements for product quality”.
 The purpose of quality control is to discover
defects Quality control is limited to looking at
products .
 Quality control is testing the final product against
product quality standards.

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Total Quality Management - Spring 2010
 Quality Control
It is that part of Quality Management focused on
fulfilling requirements of the Customers for the
quality products.

A Simplest Form of Quality Control is:-

Requirements

Plan Do Check Conforms Yes

Corrective No Product
Action Or
Service

Total Quality Management - Spring 2010 13

 Quality Assurance

 Quality Assurance (QA) - “all planned and systemic activities

necessary to provide adequate confidence that a product or
service will satisfy given requirements for quality”.

 It is defined by those activities that modify the development

processes to prevent the introduction of defects.
 Quality assurance is more concerned with the processes that produce
the final product, and making sure that quality is part of each phase.
 QA is about maturing the process towards minimum defect.
 It is about taking into account physical, human factors as well as
technological ones.

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Total Quality Management - Spring 2010
 Total Quality Assurance Total Quality Assurance

Total Quality Management

Total Quality Management

Quality Assurance Quality Assurance

(Process improvement)

Quality Control
Quality Control
(Correction of Defects)

Inspection

Inspection
(Sorting out good from bad
products)

The Phases of Development of Quality Assurance Systems

Total Quality Management - Spring 2010 15
Continuous Quality Improvement (CQI)
CQI is a cyclical process. 
It involves identifying an area (problem) where 
there is an opportunity for improvement then
outline the sequence of activities that should occur
in order to solve that problem, and implementing
them.

Once the cycle is completed it has to be 

determined whether the problem has been solved.

If the problem continues, the cycle should be 

repeated.
Continuous Quality Improvement (CQI)
Continuous Quality Improvement Cycle
(CQI)
There are seven steps involved in
implementing CQI cycle:

 Step 1 identify an area( deficit) where

opportunities for improvement exists.
 Step 2 define a problem within that area,
and outline the sequence of activities that
should occur in that problem area.
 Step 3 establish the desired outcomes of
the process and the requirements needed
to achieve them.
Continuous Quality Improvement Cycle
(CQI)
 Step 4 select specific steps in the process, and for
each step list the factors that prevent the
achievement of desired outcome.
 Step 5 collect and analyze data about the factors
that are preventing the achievement of the desired
outcomes of the desired steps.
 Step 6 take corrective action to improve the
process.
 Step 7 evaluate and monitor the results of the
action taken
Evolution of Quality Management

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What is Total Quality
Management (TQM)?

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TQM
Total Made up of the whole

Degree of excellence a
Quality product or service
provides

Art of Planning,
Management Organizing,
Controlling etc.

Therefore, TQM is the art of managing the whole to achieve excellence.

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Meaning of TQM
All persons
System Of all divisions
At every stratum

Method QC, QA
TQM means

Q(Quality):Quality improvement
C(Cost):Cost reduction
D(Delivery):Delivery execution
Purpose
S(Safety):Safety maintenance
M(Morale):Morale boosting
E(Environmental):Environmental protection
Total Quality Management - Spring 2010 23
Definition of TQM

"TQM is a management approach for an organization,

centered on quality, based on the participation of all its
members and aiming at long-term success through
customer satisfaction, and benefits to all members of the
organization and to society.”

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What’s the goal of TQM?

Total Quality Management - Spring 2010 25

Goals of TQM:
1- Customer Focus: Studying customer needs, gathering customer
requirements, and measuring and managing customer satisfaction.
2- Process Management: Develop a production process that
reduce the product variations. Applying the same process; the
same product should be produces with the same level of quality
every time.
3- Employee Empowerment (Human side of Quality): TQM
environment requires a committed and well-trained work
force that participates fully in quality improvement
activities.
On-going education and training of all employees supports
the drive for quality.
4- Continuous Improvement: TQM recognizes that product
quality is the result of process quality. As a result, there is a
focus on continuous improvement of the organization's
processes. Total Quality Management - Spring 2010 26
Pillars of TQM

T. Q. M.

Customer Process Employee Training

Focus Management & Empowerment

Continuous Improvement
(through measurement and analysis)

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Continuous Improvement versus
Traditional Approach
Traditional Approach
 Market-share focus
 Individuals
 Focus on ‘who” and “why”
 Short-term focus
 Status quo focus
 Product focus
Continuous Improvement
 Customer focus
 Cross-functional teams
 Focus on “what” and “how”
 Long-term focus
 Continuous improvement
 Process improvement focus
Total Quality Management - Spring 2010 28
Customer types

 External and Internal customers

 External : who used the service

 Internal – Every person in a process is a customer of

the previous operation.( applies to design, manufacturing,
sales, supplies etc.)
 [Each worker should see that the quality meets
expectations of the next person in the supplier-to-
customer chain ]
 TQM is commitment to customer-focus - internal and
external customers.
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 Customer/supplier chain

Outputs to external customers

Inputs from supplier

Internal customers

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What is external customer satisfaction?
 Is it due to service quality?
 Is it due to pricing?
 Is it due to organization reputation?
 Is it something more?

Total Quality Management - Spring 2010 31

 Building the quality chain

 To understand how quality may be built into a product

or service, at any stage, it is necessary to examine the
three distinct, but interrelated aspects/parameters of
quality:

1. Quality of Design

2. Quality of Conformance

3. Quality of Use

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Understanding and building the quality chains

Quality of Design: Is the extent to which

the design reflects a products or service
that satisfies the customer need or
expectations

Quality of conformance : Is the extent to

which the product or service conforms to
the design standard

Quality of Use: Is the extent to which a

product/ service is easy to use.
Total Quality Management - Spring 2010 33
 How Work Gets Done in an Organization?

 Inputs : Delivered by suppliers

 Processes : Steps to transform inputs into process by internal customers

 Outputs :Goods and Services valued by external customers

Total Quality Management - Spring 2010 34

 Managing processes
Materials

S Procedures
Product
C
U Methods U
P Information
Service
S
P T
L Process O
I M
People Information
E Skills
E
R Knowledge Paperwork
R
S Training S
Equipment

Total Quality Management - Spring 2010 35

Effects of poor Quality
1. Low customer satisfaction
2. Low productivity
3. More re-work, material & labor costs
4. High inspection costs
5. High repair costs
6. Greater waste of material

Total Quality Management - Spring 2010 36

Benefits of Quality

1. Higher customer satisfaction

2. Reliable services
3. Better efficiency of operations
4. More productivity
5. Less wastage costs
6. Less Inspection costs
7. More market
8. Spread of happiness
9. Better quality of life for all.

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