Quality Assurance and Total Quality Management PDF

lOMoARcPSD|18474540 Quality Assurance and Total Quality Management Quality Improvement (Q.I) Quality Control (Q.C)  Concerned with...

lOMoARcPSD|18474540 Quality Assurance and Total Quality Management Quality Improvement (Q.I) Quality Control (Q.C)  Concerned with performance development  On going  Refers to quality related acvies associated  Involved with xing now with the creaon of project deliverables.  Prevenng future costly mistakes  Used to verify that deliverables are of acceptable quality and that they are complete Connuous Quality Improvement (C.Q.I) and correct  On-going process of monitoring structure, Examples: process, & outcome indicators in order to - Peer reviews idenfy signal events, signicant trends and - Tesng process opportunies for change.  Involves performance management and  It integrates Q.A., Q.C. and Q.I maintenance  Includes systemac method of ensuring Dierence between Q.A. & C.Q.I. conformance to a desired standard or norm.  Q.A. – goals only aim at maintaining care quality Quality Assurance (Q.A) at a present level  C.Q.I. – on-going process through which care  Refers to the process to create deliverables, and standards & pracce behaviors are progressively can be performed by a manager, client, or even enhanced: a third-party reviewer. - Current research ndings Examples: - Pracce - Process checklist - Paent & public welfare - Project audits  Process of establishing a target degree of excellence  For nursing intervenon and taking acon to ensure that each client receives the agreed on level care. Objecves of Q.A  Set standard for nursing care delivery  Establish criteria as basis to evaluate this standard Components of Q.A Program  Clear and concise wrien statement of purpose, philosophy, values and objecves.  Standards or indicators for measuring quality of care. Nursing Care Standards  Policies and procedures for using such standards in data gathering. Standard: The desire quanty, quality or level of  Analysis and reporng of the data gathered with performance that is established as a criterion against isolaon of problems and variances. which worker performance will be measured.  Use of the results to priorize and correct Purposes: problems and variances. - Guide the provision of nursing care  Monitoring of clinical and managerial - Provide the means by which nursing personnel performance and ongoing feedback are evaluated in the provision of care.  Evaluaon of the Q.A system Downloaded by Janica Spycher ([email protected])  lOMoARcPSD|18474540 - Provide the means by which to measure the end TQM acvies include results of nursing care through paent  Commitment by senior management and all outcomes. employees.  Meeng customer requirements Standards of Care refers to:  Reducing development cycle mes Nurses conducng themselves  Just in me/demand ow manufacturing Professionally according to a  Improvement teams Generally accepted reasonable  Reducing product and service costs Pracce of nursing care  Systems to facilitate improvement  Line management ownership  Conducng themselves with the degree of care,  Employee involvement and empowerment skill, and knowledge that reasonably competent  Recognion and celebraon nurses would exhibit in any situaon.  Challenging quaned goas and benchmarking  Pracce that avoid being found negligent.  Focus on processes/improvement plans  Exercise good judgement, educaon and  Specic incorporaon in strategic planning training to the best of their ability under any circumstances. Principle of TQM Sources of Standard of Care 1) Quality can and must be managed.  Nursing Law 2) Everyone has a customer to delight.  Professional organizaons 3) Processes, not the people, are the problem.  Code of Ethics for nurses 4) Every employee is responsible for quality.  Joint Commission on Accreditaon of 5) Problems must be prevented, not just xed. Healthcare Organizaon (JCAH) 6) Quality must be measured so it can be  Case Law and Published Opinions by Judges controlled.  State Statutes and Administrave Codes 7) Quality improvements must be connuous.  Hospital Policies 8) Quality goals must be based on customer  Authoritave Nursing Journals requirements. Total Quality Management Issues & Concerns of TQM  Management Commitment  Is a management philosophy that seeks to - Plan (Drive, direct) integrate all organizaonal funcons - Do (deploy, support, parcipate) - Check (review) (markeng, nance, design, engineering, and - Act (recognize, communicate, revise) producon, customer service, etc.) to focus on  Employee Empowerment meeng customer needs and organizaonal - Training objecves. - Suggeson scheme - Measurement and recognion - Views an organizaon as a collecon of - Excellence teams processes.  Fact Based Decision Making - Maintains that organizaons must strive - SPC (stascal process control) to connuously improve these processes. - DOE (Design of Experiment), FMEA (Failure - By incorporang the knowledge and Modes and Eects Analysis) experiences of workers. - The 7 stascal tools (SPSS, R, MatLab, MS - Innitely variable and adaptable. Excel, SAS, GraphPad Prism, Minitab) - Generic management tool - TOPS (FORD 8D- Team Oriented Problem Objecng of TQM Solving) “Do the right things right, the rst me every me”. Downloaded by Janica Spycher ([email protected])  lOMoARcPSD|18474540  Connuous Improvement 1) Prevenng mistakes (defects) from occurring - Systemac measurement and focus on COQ (Mistakes – proong or Poka-Yoke). (Cause on Quality) 2) Where mistakes can’t be absolutely prevented, - Excellence teams detecng them early to prevent them being - Cross-funconal process management passed down the value added chain (Inspecon - Aain, maintain, improve standards at source or by the next operaon)  Customer Focus 3) Where mistakes recur, stopping producon unl - Supplier partnership the process can be corrected, to prevent the - Service relaonship with internal producon of more defects. (Stop in me). customers Implementaon Principles and Processes - Never compromise quality  A preliminary step in TQM implementaon is to - Customer driven standards assess the organizaon’s current reality. The Concept of Connuous Improvement by TQM  If the current reality does not include important  TQM is mainly concerned with connuous precondions, TQM implementaon should be improvement in all work. delayed unl the organizaon is in a state in  From high level strategic planning and decision- which TQM is likely to succeed. making.  If an organizaon has a track record of eecve  To detailed execuon of work elements on the responsiveness to the environment, and if it has shop oor. been able to successfully change the way it  It stems from the belief the mistakes can be operated when needed. avoided and defects can be prevented.  People need to feel a need for a change.  It leads connuously improving results, in all Kenter (183) addresses this phenomenon by aspects of work, as result of connuously describing building blocks which are present in improving capabilies, people, processes, eecve organizaonal change. technology and machine capabilies. Steps in Managing the Transion  Connuous improvement must deal not only with improving results, but more importantly Beackhard and Pitchard (1992) have outlined the basic with improving capabilies to produce beer steps in managing a transion to a new system such as results in the future. TQM:  A central principle of TQM is that mistakes may be made by people, but most of them are - Idenfying tasks to be done caused, or at least permied, by faulty systems - Creang necessary management structures and processes. - Developing strategies for building commitment  This means that the root cause such mistakes - Designing mechanism to communicate the can be idened and eliminated, and repeon change can be prevented by changing the process. - Assigning resouces The ve major areas of focus for capability TQM and CQI Processes improvement Total Quality Management (TQM)  Demand generaon  Total quality management (TQM) is connuously  Supply generaon improving quality (CQI) by focusing on  Technology customers’ requirements, improving the  Operaon processes which relate to these expectaons  People Capability and involving everyone in the process of improvement. Three major mechanism of prevenon Downloaded by Janica Spycher ([email protected])  lOMoARcPSD|18474540  TQM is an overall philosophy and management Feeling of Involves everyone and system, CQI may be used as a structured “powerlessness” among achieves commitment approach to implement TQM members and pride The TQM Formula What is a Total Quality Management?  A people-focused management system that TQM = CQI through Customer Focus + aims at connual increase of customer Process Improvement + sasfacon (from student all the way to Total Involvement employers and community) at connually lower real cost. The Concepts of TQM  It is a total system approach which works  Quality – Meeng the customers’ requirements horizontally across funcons and departments, reliably and connuously improving manner involves all employees from the top to boom,  Process – Steps/Acvies which convert inputs and everyone in the quality chain from suppliers into a valuable output for customers. to customers/  Customer – Persons/enes who use or benet from the output of a process; may be internal or How quality management diers from external to the work team convenonal management  Supplier – Person/enes who provide inputs to  Denes progress based on the purpose of the a process; may be internal or external to the organizaon, not just formal measures work team.  Improves processes instead of working only on structure, outputs or individuals. Avoids blame.  Ensures that every person understands how the system works, what it is supposed to do and how well it is doing  Opmizes the performance of the system instead of only components of the system Worst case non TQM vs TQM WORST CASE TQM NON - TQM Dictates quality to the Focused on sasfying the customer customer Quality Problem Solving Tools Passively waits for the Intent on connuously  Generang ideas -- Brainstorming complaints before improving quality as  Generang consensus on ideas -- Nominal group aempng improvement, measured by customer technique therefore reacve sasfacon, therefore  Clarifying processes -- Flowcharng proacve  Analyzing cause and eect -- Cause-eect Blames individuals for Improves the total diagram problems and solves process of work rather problems piece-meal than “blaming”  Organizing data– Check sheets individuals  Priorizing -- Pareto chart Downloaded by Janica Spycher ([email protected])  lOMoARcPSD|18474540  Showing paerns in data – Histogram  PLAN: Upgrade the documentaon; make it  Showing changes more useful. Encourage use of standard.  DO: Train to the new documented standard and Eyelash Learning Curve use. No organizaonal memory  CHECK: Compare actual with documented. Invesgate inconsistencies -- documentaon dicult to use? People don’t appreciate standard? Keeps them from doing quality work? People have found a beer way? Go to ACT. CQI Framework Rapid Learning Curve Good organizaonal memory CQI Elements Principles for Involving People in CQI  Involve those who do the work as leaders in developing beer and beer ways to do the job  Make sure they understand customer needs  Partner with specialists or other knowledgeable people who understand how the process does or should work-- people who can teach you and other employees about the underlying theory or principles that guide the work  Designate an “owner,” a person responsible for keeping visible the documentaon, for updang the standard and documentaon as improvements are idened, and for assuring that newcomers and others are trained Next Steps for Using Standards for CQI  CHECK: Ensure that purpose for standards are documented and clearly understood. Compare actual pracce with documented methods.  ACT: Reconcile actual pracces with Major Tasks documentaon, i.e., change actual or change documentaon. Downloaded by Janica Spycher ([email protected])  lOMoARcPSD|18474540 1. LIST the project name, goal, reasons for the project 2. CREATE an acvity schedule. The enre team will compose an acon plan, deem how to implement it, and then evaluate the results. Title the secons as research, compilaon, analysis, invesgaon, acon plan, implementaon and evaluaon, with relevant volunteer names and notes wrien under each secon. 3. The quality circle team works with management to DECIDE specic goals CQI Commiee Funcons against which to measure the data. then analyze the results again against project goals so that the company can prevent future excess scrap and its consequent monetary loss. 4. DEVELOP a quality circle ACTION PLAN based on the team's analysis and work with management to implement it 5. Work with management to EVALUATE the quality circle acvity QI Team process using Deming Cycle (FOCUS-PDCA)  F – ind a process to improve  O- rganize a team that knows the process  C- larify current knowledge of the process QUALITY HEALTH CARE and NURSING  U- understand causes of process variaon Quality Circles/Teams  S – elect the process improvement  Quality circles = Quality teams  P- lan the improvement  Circle is a small group of employees who  D-o data collecon, data analysis and voluntarily meet at regular mes to improvement  Idenfy, analyse and solve quality and other  C- heck data for process improvement and problems in their working environment customer outcome  recommend and implement improvement  A-ct to maintain and connue improvement strategies and be a useful reservoir for the generaon of new ideas. Sample of Quality Improvement Acvies:  members face and share similar problems in  Ideas for Change: Clinical Informaon Systems their daily work lives and o Example of #1 To provide good care for  create a programme to tap human creave people with chronic illness, clinicians need energy that is capable of generang handsome access to mely, clinically relevant rewards. informaon about each paent in the pracce, as well as the populaon of paents as a whole. o Useful informaon includes recommended Acvies in Quality Circles/Teams services (e.g., an Asthma Acon Plan), key Downloaded by Janica Spycher ([email protected])  lOMoARcPSD|18474540 outcome measures (e.g., symptom-free days, o Minimizes cost and determine if the ER visits), paent contact informaon, and recommended treatment is appropriate. paent encounter history (e.g., how oen o Gives opportunity to conrm that your paent accesses care; last me seen). This health plan provides adequate coverage for IHI sponsored webpage provides a number of your parcular condion. ideas for change and allows visitors to upload their own ideas and comments Types of Ulizaon Review 1. concurrent reviews are used for approval of Clinical Pracce Guidelines medically necessary treatments or services, Clinical pathways happen during acve management of a  are standardized, evidence-based condion, for in-paent/outpaent care. muldisciplinary management plans, which  The focuses on ensuring paent that they get idenfy an appropriate sequence of clinical the right care in a mely and cost-eecve way. intervenons, meframes, milestones and 2. retrospecve review involves the review of expected outcomes for an homogenous paent medical records aer your medical treatment. group (Queensland Health Clinical Pathways  Sta looks into the results to approve or deny Board denion 2002) coverage you have already received, and the  Nursing Audit, (Joint Audit) informaon can also be used in a review of the o a review of the paent record designed to insurance company's coverage guidelines and idenfy, examine, or verify the performance criteria for a parcular condion of certain specied aspects of nursing care by using established criteria.  Types: Complaint Analysis  Comments, feedbacks coming from dissased o A concurrent audit - performed during customer ongoing nursing care.  A customer's complaint is a blessing in disguise o A retrospecve audit - performed aer  Prompt resoluon of a complaint oen discharge from the care facility, using the generates more customer loyalty than trouble- paent's record. Oen a nursing audit and a free service. medical audit are performed collaboravely, resulng in a joint audit. Facts about Complaints  While the average customer doesn't complain Purpose of Nursing Audit to the company, he will tell ten people or more  Evaluang Nursing care given. about the problem, and these people in turn  Achieves deserved and feasible quality of will tell others; nursing care.  A complaint idenes an area of your business  Smulant to beer records. that might need improvement;  Focuses on care provided and not on care  If you suddenly see several customers with the provider. same complaint, then you have a funconal problem that needs analysis, discussion, and Ulizaon review correcon;  is a health insurance company's opportunity to  Complaints are a great tool to ne-tune your review a request for medical treatment. customer service, to get beer at what you do.  The purpose of the review is to : o Conrms that the plan provides coverage for your medical services. Downloaded by Janica Spycher ([email protected])  lOMoARcPSD|18474540  Appoint a senior consultant to be the Chair and to have responsibility for meeng management.  Appoint a registrar or fellow with responsibility How to Analyze Customer Complaints for case coordinaon and minute taking, There are three primary tools for analyzing complaints. outlining expectaons. 1. Customer survey.  Book a regular meeng me. It is a requirement 2. Policy technicians who always tell management that meengs are held monthly. about complaints. 3. Customer complaint form.  The form documents the complaint, and Purposes: forces correcve acon.  discussing management decisions o Use the les for training: How could we  providing a learning opportunity focused on have prevented this service problem? system thinking How would you have handled it  Idenfying opportunies to improve paent dierently? Could we have responded safety and quality of care. beer to the customer? Complaints  Idenfy clinicians who will form the core group should be considered not as an for the department M&M meengs, taking into inconvenience, but as a tool to be used to account, improve service.  Appoint a senior consultant to be the Chair and to have responsibility for meeng management,  Appoint a registrar or fellow with responsibility Eecve Quesons to analyze complaints for case coordinaon and minute taking,  How could we have prevented this service outlining expectaons, problem?  Book a regular meeng me. Preferably held  How would you have handled it dierently? monthly.  Could we have responded beer to the customer?  Note: Complaints should be considered not as Case analysis an inconvenience, but as a TOOL to be used to Morbidity review IMPROVE SERVICES.  Cases should be summarized and reviewed using the standardized format ;  Issues should be idened and, where Morbidity and Mortality Review Meengs appropriate, recommendaons for system  are a requirement of all medical departments change made. It is important that the person within the hospital. These guidelines have been responsible for implemenng the change is prepared to assist departments conduct idened and a due date established; eecve meengs and set the minimum standard expected. Mortality review  all in hospital deaths/incidence are reviewed Preparaon according to a standardized;  Idenfy clinicians who will form the core group  Issues should be idened and, where for the department meengs, taking into appropriate, recommendaons for system account: o the benets of a muldisciplinary change made. Note duraon and me approach involving the ‘working group’  Review implementaon of recommendaons  Provide potenal to broaden the group for  Provide an independent reviewer specic cases, where signicant input to care occurred from other clinical areas. Downloaded by Janica Spycher ([email protected])  lOMoARcPSD|18474540 Sennel Events Monitoring  All other adverse events that cause death or  Sennel Events are dened as serious adverse grievous bodily harm to paent events that cause death or severe injury to the paent and result in loss of trust in the Credenaling healthcare system by clients/paents.  is the process of obtaining, verifying and  The surveillance of sennel events , is an assessing the qualicaons of a healthcare important role of public health; It is an praconer to provide paent care services in indispensable tool for the prevenon of such or for a healthcare enty. events and for the promoon of paent safety.  Re-credenaling is the process of obtaining and evaluang data to support the connued Sennel Event List competence of the healthcare praconer to  Procedure performed to wrong paent provide paent care services in or for a  Surgery performed to wrong part of body (side, healthcare organizaon. organ or part)  Erroneous procedure to correct paent  Instruments or other material retained in Clinical privileging  is the process used to idenfy, document, and surgical site which requires successive approve the specic procedures and treatments intervenons or ulterior surgery that may be performed in a specic seng.  Transfusion reacon consequent to ABO  Privileges are granted based on the ndings of incompability the credenaling funcon and should only be  Death, coma or severe harm originang from granted for services that are currently oered error in pharmacologic therapy by the hospital.  Maternal death or severe illness correlated to  Credenaling and Privileging are required for labour and/or childbirth increased paent safety, reducon of medical  Transfusion reacon consequent to ABO errors and the provision of high quality health incompability care services.  Death, coma or severe harm originang from error in pharmacologic therapy  Maternal death or severe illness correlated to Variance Reporng and Analysis labour and/or childbirth  is usually associated with a manufacturer’s  Death or permanent disability in healthy product costs; newborn weighing > 2500 grams not correlated  In the health seng, variance analysis aempts to congenital illness to idenfy the causes of the dierences  Death or severe bodily harm due to paent fall between a services provided:  Suicide or aempted suicide by paent in o standard costs of the inputs that should have hospital occurred for the actual products it  Acts of violence resulng in injury to healthcare manufactured, and workers  The price variance idenes whether the  Death or grievous bodily harm consequent to a company paid too much for each unit of input— malfuncon with the transport system or if they paid more per actual input than it had (intrahospital and extra-hospital) planned  Death or severe injury consequent to the  The quanty variance idenes whether the incorrect aribuon of a triage code by health instuon used too much of the input— emergency services department or by perhaps it used too many materials for the emergency telephone call center number of services it renders to client.  Sudden death or injury consequent to surgery Downloaded by Janica Spycher ([email protected])  lOMoARcPSD|18474540  Variance analysis for manufacturing overhead 1. Men costs is more complicated than the variance 2. Machine analysis for materials. However, the variance 3. Materials analysis of manufacturing overhead costs is very 4. Measurements and important as manufacturing overhead costs 5. Methods have become a very large percentage of a product’s costs. Tools of TQM Introducon  Data-driven methodology  Data generated by processes The “Seven Simple Tools”  Flowcharts  Check sheets - Remember system theory: - Central tool for Quality Assurance programs  Input - Specially useful for operaonal procedures  Output - Could be derived from the owchart and  Customer supplier shbone diagrams  Interacons - Divide complex processes into simple subprocesses - A qualitave tools  Pareto Charts - is a bar graph. The lengths of the bars represent frequency or cost (me or money), and are arranged with longest bars on the le and the Types of Flowcharts shortest to the right. In this way the chart visually depicts which situaons are more  Layout owchart – example: sta movement signicant.  Data ow diagrams – example: leave approval process When to Use a Pareto Chart  Cause and Eect (Ishikawa / shbone) Diagrams - Also known as Fishbone or Cause-and-Eect - When analyzing data about the frequency of Diagrams problems or causes in a process. - Non-quantave tools (Qualitave) - When there are many problems or causes and - Somemes called the 5M Diagram you want to focus on the most signicant. Downloaded by Janica Spycher ([email protected])  lOMoARcPSD|18474540 - When analyzing broad causes  A useful way of planning is to break down tasks into a hierarchy, using a Tree Diagram. PDPC simply extends this chart a couple of levels to idenfy risks and countermeasures for the boom level tasks, as in the diagram below. Dierent shaped boxes are used to highlight the risks and and countermeasures (they are oen shown as 'clouds' to indicate their uncertain Pareto Chart Procedure nature)  Decide what categories you will use to group items.  Decide what measurement is appropriate. Common measurements are frequency, quanty, cost and me.  Decide what period of me the Pareto chart will cover: One work cycle? One full day? A week?  Collect the data, recording the category each me. (Or assemble data that already exist.)  Subtotal the measurements for each category.  Determine the appropriate scale for the measurements you have collected.  Construct and label bars for each category.  Calculate the percentage for each cate How do you do it?  Histograms  Scaer plots and Correlaon Analysis 1. Break down the task into a Tree Diagram. The boom 'leaves' on the tree will now indicate the actual tasks to be carried out. Process Decision Program Chart (PDPC) 2. For each boom-level task 'leaf', brainstorm or otherwise idenfy a list of possible problems  Is a very simple tool with an unnecessarily that could occur. impressive-sounding name, possibly derived 3. Select one or a few of the risks idened in step from the Japanese name, from where it came as 2 to put on the diagram, based on a one of the 'Second seven tools (also known as combinaon of probability of the risk occurring the 'Seven tools for management and planning') and the potenal impact, should the risk materialize. 4. For each risk selected in step, brainstorm or How does it work? otherwise idenfy possible countermeasures that you could take to minimize the eect of the risk. 5. Select a praccal subset of countermeasures idened in step 4 to put on the chart. 6. Connue building the chart as above, nding risks and countermeasures for each task. If there are a large number of tasks, you can simplify the task by only doing this for tasks that are considered to be at risk or where the 7. impact of their failure would be felt. Downloaded by Janica Spycher ([email protected])  lOMoARcPSD|18474540 10 Steps of Quality Improvement 1. Commitment 2. Improvement teams 3. Educaon 4. Measures, Display and Review 5. Cost of Quality 6. Communicaon 7. Correcve/Prevenve acons 8. Recognion 9. Event 10. Goal seng and connuous improvement Juran Quality-Based Problem-Solving / Process Improvement  Juran focused on quality control with the Quality improvement tools: "trilogy"  quality planning  Control charts  quality control  Lot sampling  quality improvement.  Process capability  An SPC representaon of the trilogy is used in  Value Analysis (VA) the gure at the right. A spec is developed -- usually with a ± tolerance. A control chart is used to get the process under control. As special  Run Charts and Control Charts causes are removed to improve the process, - Stascal Quality Control (SQC) or Stascal variaon is reduced. These are the basic steps in Process Control (SPC) for repeve, high volume Six Sigma process improvement producon began in the 1930's when Shewhart developed control charts. Small producon samples were measured periodically to monitor Value Analysis Teams quality. Sample mean (Xbar) and range (R) charts were used to detect when a process was  In Value Analysis, developed by Larry Miles at GE going out of “"economic detect when a process during WWII, mul-funconal teams (design, was going out of "economic control." producon engineering, purchasing, quality) use a formalized process to idenfy alternave Deming PDCA materials, manufacturing processes, and designs  The Deming Shewhart Cycle was especially useful to improve funcon while reducing costs. in solving these quality problems. The PDCA  The "Job Plan" for a Value Analysis study of a Circle denotes connuous improvement by specic product or process has the following repeang the basic cycle of format  Plan – Get the data – Analyze the problem – Plan  Pre-Study the soluon  Collect customer data  "Do" It  Collect product and process data  Check -- Measure the change  Build product and process models  Act – modify as needed as long as signicant  From the mul-funconal team improvements are obtained  Study  Informaon Phase – analyze data  Funcon Analysis Phase – idenfy and cost funcons  Creave Phase – brainstorm ideas Downloaded by Janica Spycher ([email protected])  lOMoARcPSD|18474540  Evaluaon Phase – rank then develop ideas ISO/QS9000  Development Phase – quanfy benets and  ISO9000 was developed as a standard for plan acons business quality systems.  Presentaon – make oral report and prepare  To be cered, businesses needed to document wrien reports their quality system and insure adherence to it  Post-Study (added more recently) with reviews and audits.  Complete changes  A key element was the idencaon of  Implement changes nonconformances and a Correcve Acon  Monitor changes System to prevent re-occurrences.  Specic quality improvement methodologies were not prescribed  The automove industry adopted the QS9000 standard for their suppliers to require the use of specic pracces in quality planning and in Teams producon operaons.  Japanese Quality Circles demonstrated the  Advanced Product Quality Plans eecveness of worker teams in idenfying and  Design / Process Failure Mode and Eects solving process problems in their work area. Analysis (FMEA)  However, most serious quality problems in non- manufacturing (as well as manufacturing) organizaons arise in acvies that involve more Brecker Process Improvement than one department / funcon.  Brecker Associates integrated the :  Quality Circles has evolved into Kaizen, which  Team-based Process Improvement of ulizes mul-funconal worker and producon TQM engineering teams to improve quality and  Data gathering and brainstorming of VA producvity in a given process.  Quality methodologies of QS9000 –  The teams use TQM techniques in implemenng Stascal process control of Juran "Lean" manufacturing methods. TQM  Total Quality Management (TQM) emphasized - using mul-funconal teams (professional sta and workers from all departments involved) - to solve problems. - The teams were trained to use basic stascal tools to collect and analyze data.  Check sheets  Pareto diagrams Credenaling  Histograms  Run charts  Credenals = cercaon;  Flow charts  Process by which an agent qualied to do so  Cause and eect diagrams grants formal recognion to and records such  Force eld analysis status of enes (individuals, organizaons,  Scaer diagrams processes, services, or products) meeng pre- determined and standardized criteria. Downloaded by Janica Spycher ([email protected])  lOMoARcPSD|18474540 Accreditaon  Voluntary process by which a nongovernmental enty grants a melimited recognion to an organizaon aer verifying that it has met predetermined and standardized criteria Porolio  a porolio is a collecon of investments; - evidenary documents; - informaon intended to expand and provide evidence of accomplishments; - it include skills and experiences, in the academe, workplace, and community service Downloaded by Janica Spycher ([email protected])