Continuous quality improvement focus

In the 1990s the major focus was on system validation, on assuring the quality control (QC) of the hardware and software that operated the manufacturing process, automated the laboratories, and controlled the inventory. As that validation process achieved mainstream acceptance and majority saturation it is appropriate to ask What next Where can we and the regulators most productively next turn our attention to maintain continuous quality improvement ... 

Focused or targeted medication use evaluation follows a reasonably well-established cycle identification of a potential problem in the use of a specific drug or therapy, collection and comparison of data, determination of compliance with a pre-established guideline/expectation, and action as needed to improve discrepancies between expected and measured results. This type of medication use evaluation provides an excellent opportunity to apply the Shewhart cycle for continuous quality improvement (Figure 26.3). Focused medication use projects are typically selected for a specific reason. Table 26.4 lists reasons to consider drugs for focused evaluation projects. 

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)—JCAHO began providing accreditation services by focusing on hospitals more recently, its services have been expanded to provide accreditation services for a wide continuum of healthcare providers. In fact, JCAHO shifted its accreditation focus toward a continuous quality improvement (CQI) process and incorporated outcomes measures into the standards. Information on JCAHO and its standards can be found at www.jcaho.org. 

Continuous quality improvement, flexibility, and fast product changeover, market focus, short product life cycles, total system optimization which includes just-in-time raw material and product delivery, computer-integrated manufacturing, and partnering with customers will ail be second nature to successful companies. Technology will play a critical role in all this and no nation or part of the world will have a monopoly. Execution of these skills will often be a key differentiator among competitors. 

Often quality improvement activities are necessary for accreditation. Earning accreditation indicates that an organization has met predefined standards. The accreditation process provides a framework to help organizations focus on providing safe, high-quality service and requires that the organization demonstrate to outside reviewers its commitment to continuous improvement (Ovretveit, 2001). 

To foster a partnership to manage continuous improvement in quality by focusing on processes, people, and culture. 

Until recently, methodologists interested in systematic reviews have focused on studies of the effects of interventions, especially drugs, on patient outcomes. That work is generally applicable to systematic reviews of diagnostic tests that start with a question of the second type above. The opportunities to use the techniques, however, are limited as it is unusual to find more than one study on any combination of a test and an outcome. We therefore focus on systematic reviews of the diagnostic accuracy of tests and express the hope that the quality of primary studies will continue to improve so that many such systematic reviews will become feasible. 

Current quality efforts focus mostly on problems in assembly plants. They also address continuous improvement after a component is in production. Suppliers are continuously graded on their performance, and low performers are subject to corrective action, even if the parts they provide are carryover parts that have no design changes. 

Total quality management is an approach that seeks to improve the quality of the value proposition that the organisation delivers to the customer in the most effective and efficient way possible. Based on the ideas of continuous improvement it requires the whole organisation to embrace the concept and cannot be undertaken by a department or group of managers alone. It requires the company to work as one team to focus on quality improvement in all systems and processes. Some times referred to as the Deming philosophy. 

Principles of Quality—course covering the background and application of quality concepts. Topics include team skills, quality tools, statistics, economics, and continuous improvement. Focuses on the application of statistics, statistical process control, math, and quality tools to process systems and operations. 

Early laboratory and field study work carried out by Adam and Scott (1971), Adam (1975), McCarthy (1978) and Kim and Hammer (1976) had already demonstrated the potential of behaviour modification techniques in a quality improvement process. These studies, however, tended to focus on specific, time-bound experiments within a particular setting or occupation. We were much more interested in applying a behaviour-based approach within a plant operating a continuous production process, involving several departments, and consisting of multiple skills and skill levels. So, it seemed to us that quality behaviour, unlike safety behaviour, would be contingent on interactions with other people and we would need to optimize... 

DaimlerChrysler supplements these requirements with its own procedure for new-product introduction. DaimlerChrysler characterizes its quality efforts two ways — advance and current. DaimlerChrysler refers to efforts to anticipate problems as "Advance Quality Planning" (or AQP). As the name implies, the hope is to head off problems before they happen. Current quality efforts focus mostly on problems in assembly plants. They also address continuous improvement after a component is in production. Suppliers are continuously graded on their performance, and low performers are subject to corrective action, even if the parts they provide are "carryover" parts that have no design changes. 

The advent of ISO 9000 certification has helped bring the quality issue to a focus. While ISO 9000 emphasis is on documentation of methodology and performance to the documented methods, the discipline that results is a direct step toward improvements in reliability. Out of this seems to come a goal of continuous improvement. This is a sharp contrast to the high growth era that took place in the early 1980s when poor quality on the part of the equipment suppliers was a significant factor in the lack of reliability at the field operation level. 

In spite of the good results obtained we continue our search for simple auxiliary conditions directed at ensuring that the approximated matrix is positive and that its trace has the correct value. This search is mainly focused at improving the quality of the 2-RDM obtained in terms of the 1-7 DM, which at the moment is the less precise procedure [46]. When this latter aim is fulfilled we expect that the iterative solution of the 1-order CSchE will also be successful although in this CSchE the information carried by the Hamiltonian only influences the result in an average way which probably will retard the convergence. 

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