how to improve cqi?

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Let’s say you run a business where you make customized jewelry. You take orders and make deliveries every two days. But even after years of work, you notice you don’t always deliver on time and even mix up orders. You have to start over again to get the details right. You’ve lost time and resources, and now your customers are upset.

You don’t want to go out of business, so now you’re looking for ways to improve your process so the products exceed expectations for the customers. What you need is a continuous quality improvement strategy.

Continuous quality improvement (CQI) is a means for attaining quality in various endeavors. It helps you understand what you’re doing and how to improve on it. It builds on quality to attain higher standards. Humans are constantly improving who they are and what they do to be valued more. Most people only think and wish to be better, yet only a few act on their desires and achieve their goals.

But how can you make sure that your changes follow the rules of CQI?

This article covers what you should know about continuous quality improvement and why you need it if you’re aiming to hold the market. It has been divided into the following parts.

Chapter 1: Definition and History of Continuous Quality Improvement

Chapter 2: How to Implement CQI

Chapter 3: Components of CQI Culture

Chapter 4: Importance of Continuous Quality Improvement

Chapter 5: Methods of Continuous Quality Improvement

Chapter 6: Best CQI Methods to Use

Chapter 7: Barriers of CQI

Chapter 8: Using SweetProcess on Your CQI Journey

Conclusion

Continuous quality improvement (CQI) is a process that ensures that something doesn’t have to go wrong before you fix it. It lets you foresee a problem and deal with it before it happens. This process is data-driven (it uses data to instruct changes) and involves the contribution and collaboration between employees at all levels of an organization and management. Continuous quality improvement is a deliberate act to see that programs are constantly improving. It lets you serve your customers better.

CQI encourages members and owners of organizations to look for ways to foster a learner production and create an environment of continuous change and adaptation. It acknowledges that problems are caused by processes, not people. Hence, it discourages fear and blame in the employee hierarchy. In CQI, quality is achieved when you meet or exceed the needs of customers. This can be achieved by monitoring service quality and customer satisfaction by using valid data and getting feedback.

CQI was first developed in the 20th century by Walter Shewhart. He developed it as a means of addressing procedural problems before mistakes could harm products. His statistical process control can be traced to the 1920s and 1930s as the beginning of CQI. His method enabled employees to track changes in processes and product output using a chart. This method let them fine-tune work as it was completed.

Walter’s student W. Edwards Deming refined his concepts, landing finally at what we now know as continuous quality improvement. He was influenced by Walter’s Shewhart line. The Shewhart line was a three-step scientific process of specification, production and inspection. Deming reasoned that results would be better if the steps were in a cycle rather than a straight line. The Shewhart line then became known as the Shewhart cycle. In 1950, Deming further improved on Walter’s idea and created a new version known as the Deming wheel or cycle. This concept’s newest modification is now known as the PDCA cycle.

CQI is mostly used in healthcare, social services and education. However, it is not limited to be used by these structures since its framework can be employed by any organization. The successful implementation of CQI is a long process. Learning about its benefits will encourage you to put in the needed work in your organization to see improvements.

To Implement continuous improvement in your organization, you should consider the following:

To begin your CQI journey, you should let your workers know what you’re expecting and how they are to perform. They will need to have a culture of CQI (as you’ll learn in the next chapter).

Create a team in charge of your operations for change. Teams should meet regularly to create and restructure policies using available data.

Consider what areas your business is lacking in and what can be done to improve on it. What CQI strategy you’ll use is dependent upon your areas of concern.

To see how far you’ve come, how you’re doing and where you’re going, do well to always take data at each step of the way. It is effective in learning what is working and what isn’t.

This is important as it lets you have a better understanding of how things used to be and what they are like now that you’ve begun the process of change. Having data at hand makes it easier to track and adjust changes.

Employees should always report observations to those heading your QI team. They have to be conscious and alert to not miss any change as it happens.

CQI is about teamwork. Promoting an individual is not the goal. Every employee and management work together to achieve a goal. Include your customers in this process by getting their feedback on your products and services.

As you’ll learn in this article, continuous quality improvement is a process that should not end. Results from whatever CQI method you choose to use may not be immediate. However, if you remain committed, you’ll like what you’ll be getting.

CQI has some core principles which it is noted for, all of which have to be present in the work environment and imbibed by the workers for it to be said that it has a culture of CQI. Watch Mark Anderson describe what makes a CQI culture.

Research has shown that more people die in hospitals from mistakes than from natural causes each year. In other sectors such as finance, time, output, inventory, customer satisfaction and others, mistakes might not be as fatal but they can cause some serious drawbacks to various aspects of an organization.  A CQI prevents these from happening by improving the quality of processes and procedures. Other benefits of CQI include:

Numerous methods for improving quality in an organization abound. Five methods are commonly used more than others. The major methods of continuous quality improvement are listed below and discussed:

The PDCA method for continuous quality improvement was developed by W. Edwards Deming. (also known as the Deming method). It is an established tool for achieving continuous improvement. It involves testing possible solutions, assessing the results and pushing forward the ones that worked. It breaks down the process into smaller steps and explores ways to improve each one of them. It is a four-step cycle for problem-solving. The steps are: plan, do, check and act.

Plan: Here, goals are set and actions needed for change are determined. Information about current processes and customer needs is collected and analyzed. This is a three-part step involving the identification of the problem, analyzing it and developing an experiment to test it.

The roles of individuals will be given as well as a timeline for completion of each task. You recognize an opportunity and plan a change.

Do: Carry out a small-scale study to test your potential solution. As the plan is put into action, document your findings. This documentation should include any issues and unexpected occurrences.

Check: Analyze findings and document lessons learned after implementation. Information is looked at to see if goals have been achieved. Check whether your ideas were successful as you compare with your expectations.

Act: Take action based on what you learned in the study/check step. After checking your findings, determine what actions need to be taken to improve on your already existing processes in the long run. If the desired goal was achieved, the newly created process should be added as part of the organization’s routine.

The PDCA method is an unending cycle. So in the last part, (act), you repeat the process if it didn’t work out the first time or for even better results. Due to the long time frame for applying this method, it may not be the most appropriate approach for dealing with an urgent problem.

When should you use the PDCA cycle? You should consider using this methodology when:

This method for improving quality makes an organization clearly define its goals. This model was created by the Institute for Healthcare Improvement Collective to address social problems. This model employs the PDCA method and asks three fundamental questions. By asking these three questions, it guides the organization on the proper steps to take.

In the first question, your company’s goals and objectives are outlined clearly. This gives you the means to know when a process is working in line with your goals. It also ensures that everyone is working toward the same goal. After you’ve identified the problems that need solving, make a plan to change them. The plan should be specific, timebound, aligned and quantifiable. It is hard to change what you can’t measure.

At the second question, ideas on how to improve are brought and plans to execute it formed. It encourages team members to identify specific changes that can be tested readily. Not every change suggested will lead to an improvement in quality. According to your goals, you should be able to tell if a change was successful or not. Setting up measurements at each stage lets you determine this.

At the third question, track your progress against your target to know how successful a change has been.

When combined, the three questions and the PDCA cycle form a framework to support continuous improvement. It is based on the five principles of improvement. These are the five principles:

The Lean method focuses on removing wastes in ongoing processes. It was developed by Toyota Corporation to improve value to customers and employees while reducing waste. It outlines seven types of waste: transport, inventory, motion, waiting, overproduction, over-processing, and defects. Using this model as a method for continuous quality improvement ensures that more time is spent performing value-added tasks. This is possible because overburden and inconsistency are reduced to create a process suitable for delivering the required results. This method identifies valuable processes and those that are not. Lean focuses on increasing customer value while optimizing operations. It sees that workflows and tasks are efficient and effective. Value is looked at from the customer’s point of view. You deliver what the customer needs when they need it. While doing this, use as few resources as possible so there is no waste. It involves building a culture that respects all employees and enables them to share ideas for continuous improvement.

This model was developed at Motorola by Bill Smith. It goes with the Lean model. It is used to find and eliminate causes of problems and variations in process and output. It recognizes that defects are the fault of processes. It aims to reduce the rate of error in processes. Using this model, processes and outcomes to be improved are defined, performance is tracked through data collection, processes are analyzed to know how they’re doing, and results are improved.

This model ensures that processes that add no value are cut out. Error elimination is the goal of Six Sigma. It tries to reduce the possibility of errors to the barest minimum. Six Sigma stands for the Greek letter sigma which is a statistical symbol that represents a standard deviation. It is used because a Six Sigma process is expected to be correct 99.99966 per cent of the time. This only gives room for a 3.4 defect for every million opportunities. According to Ssix Sigma, processes that do not satisfy the customer are seen as a defect and should be removed from the system to ensure superior quality of products and services.

Six Sigma is designed to suit large organizations having quality management problems. A sequence of steps is defined around a particular target to achieve its target. It streamlines quality control for there to be as little to no variance as possible throughout the production processes. There are two methodologies of Six Sigma: DMAIC and DMADV.

This methodology is used to improve a new product or process that doesn’t meet expectations. The steps are simple to follow.

Define: Your goals and expectations, problems, customer expectations and project requirements are defined.

Measure: See how current processes are performing. Collect and record data to know areas of defects.

Analyze: Analyze your processes. Learn the causes of variations and defects to spot issues working against your current processes and final goal.

Improve: With knowledge of your processes defects, improve on processes based on what you have gathered in the previous stage. Create new projects that will ensure you have better quality.

Control: Take control of your new and established processes so it stays on track and does not become defective.

This method is also known as the design for Six Sigma (DFSS). It aims to create new ideas to help business processes.

Define: Set achievable goals regularly, suiting to the customers’ requirements and your business strategy.

Measure: Measure and identify the customers’ need for quality services and make them into project goals.

Analyze: Study various options for satisfying the customer while estimating the total life cycle of the project. Analyze high-level alternatives that’ll ensure superior quality.

Design: Create a high-level process after which a more detailed prototype is created to identify errors and make changes.

Verify: Check that your final process is approved by all customers and clients. After verification, implement the process.

These two methodologies appear similar but they have a specific focus. While DMAIC focuses on improving existing processes to meet the customers’ needs, DMADV focuses on creating new strategies and policies.

If you’re going with the Six Sigma approach for continuous improvement, here’s a few things to keep in mind:

The Malcolm Baldrige Quality Award developed from an honor given to organizations to recognize quality as an approach that enabled continuous excellence. The award was established by the U.S. Congress in 1987 to raise awareness of quality management and recognize companies that have done so successfully in the country. It is known as the nation’s highest presidential honor for performance excellence. This model aims to make strategic changes to an entire organization. It focuses on enterprise-level improvement through communication, productivity, and effectiveness. It is given annually in six categories: manufacturing, service company, education, healthcare, small business and non-profit organizations. Those who receive the award are selected based on achievements and improvements in seven areas known as the Baldrige criteria for performance excellence.

This model better suits an enterprise-level improvement rather than a single business. The man associated with this award, Malcolm Baldrige Jr, the late U.S. Secretary of Commerce, believed that quality was the key to prosperity and economic growth.

Continuous quality improvement is not a one-size-fits-all venture. As the needs of companies differ, so will the solution to apply to a problem be different. You find out what suits your organization better and follow that. Take Six Sigma, for instance. It is better suited for big organizations having a minimum of 500 employees. Each method of CQI has its strengths that are better suited for a particular problem area. You might even need to combine methods to get what you want. What matters in the end is that you see your chosen method through to the end and not quit.

Before you begin the process of CQI, you must know that there will be some challenges ahead. Prepare yourself since some factors will resist the changes you’re planning on accomplishing. Some of them are internal and others are external.

Take a look at this video to learn more about CQI and its barriers.

Before beginning your CQI journey, you should ensure that your processes and procedures are properly documented. Without having any idea of what your current processes are, making improvements is hopeless. Documenting processes and procedures gives you a starting point to look closely at what you’ve been doing and how you can improve on it. During your CQI journey, as you’ve learned, data collection is important. This is where SweetProcess comes in. SweetProcess is a software that has proven to be the tool organizations wishing to see good improvement in their day-to-day activities need over the years.

First, let’s see how Ginkgo Residential was able to get its employees on the same knowledge level and increase employee efficiency using SweetProcess.

Sarah Genay, the portfolio analytics manager at Ginkgo Residential (a real estate company) was placed in charge of documenting the company’s procedure. Knowledge wasn’t distributed evenly in the company and it affected employee performance negatively. SweetProcess was the tool that made documentation of processes and procedures effective. While using SweetProcess, she also noticed that it made improving quality easier. The program allows everyone to be active in decision-making—a core aspect of continuous quality improvement.

Next, we see how Atlantic Sapphire, a salmon farming company, was able to streamline workflow using SweetProcess.

Stanley Kolosovskiy, the technology process coordinator at Atlantic Sapphire, was in charge of making sure that the organization’s business operations were optimal. As a company interested in delivering products to customers without polluting the environment, employees had to comply strictly with operating procedures. But this wasn’t happening the way Stanley liked because an effective workflow system was missing.

SweetProcess was what the company needed and it proved itself as a system for documenting processes and procedures that employees would use. Unlike the hard-to-use ones, SweetProcess is user-friendly and employees are not daunted when referring to it. The company experienced for itself how thorough this software is in capturing data and managing changes. Any employee can notice when a process isn’t captured right and report to the manager right there on the software—very necessary in continuous quality improvement.

Finally, Forensic Consulting Services, an environmental health consulting firm, was able to build a more efficient workforce using SweetProcess.

The director of operations at Forensic Consulting Services, Kevin Trapp, was responsible for ensuring efficiency and consistency in the organization. As the company expanded, he saw that achieving this was not easy if the workflow was not streamlined. A system was needed to do this efficiently. Not being able to put in a lot at work because of frequent questions from employees interrupting his activities made him realize things had to be done differently. He discovered SweetProcess and the company experienced employee efficiency and growth.

Nothing beats quality, and the customer expects and deserves quality service. Continue looking at how you can improve services from their perspective. Embrace a habit of CQI in your organization for a better customer experience. To make this journey easier, sign up for a free trial of SweetProcess. Our free checklist should help you make the most out of your continuous quality improvement journey.

Occasionally, CQI can be considered a part of performance management, which is the long-term evaluation of programs to ensure that they meet goals. Performance management has two parts: CQI, which offers teams the opportunity to test and implement new strategies as they work, in shorter improvement cycles; and process evaluation, which an outside group may conduct by looking at key issues from a systemic perspective. Organizations may also use performance management to encourage team members to participate in improvement efforts.

Origins and Brief History of CQI The formal pursuit and management of quality in the 20th century traces back to Walter Shewhart’s statistical process control models from the 1920’s and 1930’s. Shewhart demonstrated that employees could track variation in processes and product output on a chart, which allowed them to fine tune work as it was completed. Such activities not only produced superior products, but also empowered employees to learn more about their work and be accountable for it. Shewhart’s student and colleague, W. Edwards Deming further refined the concepts, which eventually found their way into quality management philosophies such as TQM, and then to continuous quality improvement. Here’s a 1994 interview with Dr. Deming on his thoughts about quality and innovation in the workplace.

As one National Institutes of Health article, “Assessing the Impact of Continuous Quality Improvement/Total Quality Management: Concept versus Implementation,” explains:

CQI/TQM differs from the traditional quality assurance in many ways; Among the most important is CQI/TQM's focus on understanding and improving underlying work processes and systems versus the traditional quality assurance emphasis on correcting after-the-fact errors of individuals.

CQI was first used in manufacturing, and Joseph Juran, Brian Joiner, and Philip Crosby expanded the concept to other business areas. By the 1970s, quality management began to move beyond factories to transactional and service fields.

According to Michael Decker, MD in “Beyond Infection Control: The New Hospital Epidemiology,” in health care, quality measurements were originally based on how well an organization followed given standards. As Decker writes:

When a standard was not met, the response was often to seek a miscreant who could be punished for the transaction. Attention was directed almost exclusively to the performance of physicians, with little recognition given to the roles of other participants in the process or to the organization of the process itself. The definition of quality rarely encompassed such considerations as patient satisfaction or the needs of families, employers, or other healthcare providers.

As insurers, government, and other agencies began to demand quantitative proof of quality based on set procedures, it was clear that a new approach was necessary. CQI not only uses data to instruct changes, but also seeks change from within the system and likewise looks for answers from the people in the system. Additionally, in CQI, quality is defined by meeting or exceeding the needs of customers, whether internal or external.

Now that you've planned, implemented, and evaluated your home visiting program, you've probably learned a lot. It is important to take time to examine what has been learned in order to know what should be modified in order to improve the program over time. To help you do this, the tasks in this step are based on a strategy called Continuous Quality Improvement (CQI).

CQI is a process of regularly considering information about planning, implementation, and desired outcomes in order to improve program quality. Step 9 involves a simple but systematic review of all your previous work to see what changes you could make to improve your program in the future. Regularly assessing program performance can also help you adapt to unforeseen changes in context that arise after you have started your program.

The CQI review is actually pretty simple. When you sit down to look over all that you've learned and accomplished in the previous eight steps, ask yourself and your staff a simple question—what can we do better?

Here are some suggestions for preparing for your CQI Review:

To help you review your work and answer this question, we've provided a CQI Tool that helps you to reexamine the previous eight GTO steps to determine how your plans went and prompts you to think about what you might do differently next time.

If your CQI assessment suggests that you should make significant changes to your program or change the program you are delivering, it may be premature to go on to Step 10. We recommend you take some time to figure out what needs to be changed and how you'll do it. You may need to go back and re-do some of the tasks in previous steps. The authors of this manual are in the process of developing a more in-depth manual related just to CQI, Promoting Success: A Getting To Outcomes® Guide to Implementing Continuous Quality Improvement for Community Service Organizations. Feel free to contact the first author for those materials, which will lead you through a more detailed process on how to use process and outcome data to identify areas for improvement and institute improvements to enhance program outcomes.

Keep in mind that adjustments to improve the functioning of your program do not need to be major. You may find, for example, that the delivery of case management could be improved by working with one case manager to help him or her engage with clients more effectively. Such adjustments can be made while keeping other successful elements of your program moving ahead.

It's also important to keep in mind that CQI is a continuous process, and thus CQI should be integrated into how the organization functions in an ongoing way, rather than being a one-time event. These processes could take place as frequently as every 90 days to once each year.

In each chapter, we've tried to suggest ways you could begin thinking creatively about how to implement and sustain your program at each stage of its development. In Step 10, we'll summarize these and other ideas for sustaining the successes of your program.

• A focus on improving services from the client's perspective.
• Meaningful engagement at all levels is required for success.
• Recognition that all processes can be improved.
• Continual learning using an “all teach, all learn” philosophy.
• Decision-making is improved by using both data and team knowledge.