What Is Quality ?

Menurut Juran (Hunt, 1993 : 32 )

Fitness For Use= Kecocokan penggunaan
5 ciri utama = Teknologi, yaitu kekuatan daya tahan
Psikologis : Citra rasa / status waktu,yaitu
kehandalan, kontraktual, ada jaminan
etika, sopan santun ramah atau jujur
Memiliki 2 Aspek utama, yaitu ciri-ciri produknya
memenuhi tuntutan pelanggan dan tidak memiliki
kelemahan.
 Menurut Crosby (1979 : 58)
Lihat : Crosby, Philip B (1979), Quality Is Free, New
York, Mc Graw Hill Book Inc.

Conformance to Requirement
sesuai dengan yang disyaratkan atau distandarkan.
standar kualitas meliputi bahan baku, proses
produksi dan produk jadi.
 Deming (1982 : 176)
Lihat : Deming, W. Edwards (1986) : Out Of Crisis
Cambridge : Massachussets Institute Of Technology
Kesesuaian dengan pasar or konsumen

Feigenbaum (1986 : 7)
Lihat : Feigenbaum, Armand V (1991), Total Quality
Control, 3 ed, New York, Mc Graw HillBook Inc.
Full Customer Statisfaction
Kepuasan Pelanggan sepenuhnya.
 Garvin dan Davis (1994)
suatu kondisi dinamis yang
berhubungan dengan produk, manusia,
naker, proses dan tugas, serta lingkungan
yang memenuhi atau melebihi harapan
pelanggan
 Quality Is :

Product specification and standar

Conformance to Requirement

Fitnes For Use

Zero defect

Customer Satisfaction

Ability to satisfy needs

Service Quality Model
Word Of Mouth Pase Experiences
Personal Needs
Communication

Expected Services

Perceived Services
Gap 1
External
Communication
To Customers Service Delivery

Translation Of Perception Into Service Quality Spesification

Management Perception Of Consumer Expectation

 Conformane Quality
OK

Requrement Quality
Satisfied

Quality Of Kind
Delighted
 Satisfaction

Attractive
Quality

Level
Quality

Expected Quality

Noraiki Kano
Hinshitu (Quality ) 1984
 Quality Of Medical Care ?

The extent to which the care provided is expected to achieve

the most favorable balance of risks and benefits.
A. Donabedion, MD (1980)

The effect of care on the health of the individual and muse

be differentiated from the effeiciency of medical care.
Rustein et al (1976)

Quality as a capacity to achieve a goal

G.Steffen, M.D. (1988)
 High Quality Medical Care

Produce optimal improvement in the patients physiological

status, phisical function, emosional & intelectual performance, and
comfort at the earliet time.

Emphasize promotion of health, prevention of disease or

disability, early detection and treatment of such condition.

Be provided in a timely manner

 Seek to achieve informed cooperation and participation of the patient in the
care process & decisions
Be based on accepted principles of medical science and proficient use of
appropriate technological and professional resources
Be provided with sensitivity to stress and anxiety and with patients over all
welfare
Make efficient use of technology and other health system resources
Be sufficiently documented in the patients MR to enable continuity of care
and peer evaluation
source : Council on Medical Service
(JAMA 1986)
 Rework and Waste

Yes No
Rework Soughand Dissatisfied
Rework
effective Customer

Produced Yes No
Service
Acceptable to Acceptable to
Product Satisfied Customer
provider Costomer
Or
Information No

Rework Cost
No Waste
effective

Yes

Reworks
 Cost Of Quality
Prevention Costs : Design review
Supplier evaluation
Operattion training
Quality audits
Preventive maintenance Etc
Appraisal Costs : Inspection and test
Product Acceptance
Status Measurement and
Reporting
Failure Costs : Corrective action costs
Rework
Waste
Warranty
Low Compliance
Legal liability
 Structure Proses Outcome

Characteristics of the Test performed by the

Results of test
diagnostic laboratory laboratory

Phisicians Test ordered by

Caracteristics physician

Interpretation of
physician

Diagnosis of the illnes

Treatmen chosen and

executed by
physician, other
personel and patient
Change in patiens
health
 Zero defect / right
the first time

Patient
Satisfaction/
Process / professional
standard Quality Response to need &
expectation

Enhancement of
quality of life and
excellence
 Approaches To Improve Quality
Approach Impact

Inspection Identifies & removes unacceptable

services, product or information
Almost always creates rework,
delays and addictional cost

Prevention Improves processes causing poor Q

Reduse rework, waste, delays &
costs

Planning and Design Plans processes and design to meet

and exceed costomers requirements
Reduces unnecessary activities
reduces cost and increses revenue
 QA TQM

Customers Regulators Int / eksternal

Motivation Reactive Proactive

Performance Individual Process

Process approach Idealized Actual

Method Inspection /feedback Data driven /

process improvement

Use of statistics Limited Pervasive

 Quality Management Systems

QA / ISO 9000

Re engineering

QA / ISO CQI
 Integrated Way To Systems
Quality Hospital

Hospital Accreditation
Policy
Deployment

Q
QCC
ISO 9001 5-S
ISO 14001 TQM / CQI
ISO 18001
 Total Quality Management

= Everyone & every part

Total

Quality = Customer oriented,

Not provider
Not doctor
Not Management Oriented

Management = Managing Process with data

 Process
Orientation
Customer
Focus Leadership

Common
Vision Worker
empowerment

TQM
Quality
First Education a
training

Manajemen by
fact Cross function
team work

Learning &
continous Supplier
improvement partnership
 New Str.plan
Leadership (Renstra)

Corporate Scientific
culture managemen

Organization Group
Development Dinamis

TQM
Socio
Training &
technical
Development
system

Linking pln Achievment

organization motivation
Employed
involvement
 PDCA and SDCA
Cycles
Plan

Standardize

Act Act Do Do

Check

Check
Why combine strukture, Process, and Outcome in
Quality Assesment and Quality Assurance ?

Multidimensional assesment of Quality

Identification of sites and causes of failure, and suggestion of
appropriate actions
Increase in confidence in the validity of the inferences about
quality
Sugesting problems, in case of disagreement
Incoplete, inaccurate, deliberately falsified data
Inappropriate time window, insufficient number of cases,
or without case-mix standadization
Faulty model of the relationship among structur, process
and outcome.
 Dimensions Of Performance

Doing the right thing

Efficacy
appropriateness
Doing things well
Availability
Timeliness
Effectiveness
Continuity
Safety
Effciency
Respect and caring
 Quality Improvement

Unit Optimazion / Optimization

Risk Management

Quality Assurance

Continuous Imprvement

Horizontal Integration

Vertical Alignment
 Patient Satisfaction Questionnaire

o Interpersonal Relationship
o Technical Quality
o Accessibility / Convenience
o Finance
o Efficacy / Outcome
o Continuity of Care
o Physical Envoronment
o Availability
 Phase 1 Develop understanding of TQM How to achieve TQM /
Awarcness and CQI
commitmen Top Managemen Comitment

Phase 2 Perform internal quality assesment provide education to

Planning key personel set vision and objectives

Name the proses & state purpose.

Provide training to all personnel
Conduct internal & ext.surveys
Phase 3 Formulate a quality council
Programming Perform competitive bencmarking
Form quality improvement teams
Establish measures and indicators.

Privide on going education

Phase 4
Form new committees
Implementing
Recognize & reward improvement

Phase 5 Evaluate program annually

Evaluation Redesign or revise program

Source : Motwani et al : Implementing TQm in the health care sector

Health Care Management Review, 1996.
21 (I) pp 73 - 82
Organizational Culture & Transtiton Management

Organizational Change
1. Denial
o Communication &
Kubler Ros
support
2. Anger
1. Denial and isolation
o Including people in
planning
2. Anger
3. Resistance
o Training & support
3. Bargaining
4. Exploration
o Tool, tecnique &
4. Deppression
time
5. Commitment
5. Acceptance
o Rewarding &
Creating new thing
 Juran Quality Improvement Journey
1. Decide to pursue total quality
Detrmine why you need to change
Understanding your options
Select total quality
2. Prepare for the journey
Educate upper management
Form a quality council of upper management
Prepare plans and objectives
Communicate actions
3. Start the journey
Conduct pilot quality projects
Build basic infrastructur of support
Communicate result
4. Expand effort
Include all organizational unit
Add more quality teams
Include teams for quality improvement, planning control,
cross-functional business process, & benc marking
Provide adequate training
Develop quality indicators throughout organization
5. Integrate the entire organization
Set systematic quality goals from the strategic to the
individual
Involve everyone
Manage key business prcess-cross functionally
Review and audit result.
 5 S = Estabilishing and maintaining
5S

BPR Bussines process Re enginering =

Re-define, re-design, re-enginering
QCC Quality Control Circles = team work to contribute
to improvement

ISO 9001 = Quality Management System

ISO
ISO 14001 =
ISO 18001 =
TPM Total Produktive Maintenance.

TQM
 5S

Seiri Organization

Seiton Neatness

Seiso Cleaning

Seiketsu Standardization

Shitsuke Discipline
 Steering Team

Patient care Patient Care Supporting

team RI Team RJ Team

Quality Improvement
Team
Managing Leading
Control Coaching
Quantity Quality
Opinion Data
Resistance to change Open to change
People as commodities People as resources
Suspicion Trust
Compliance Commitment
Internal Focus Customer focus
Individual Team
Detection Prevention
 Leadership Continuum

Autocratic Participative Empowering

- Tells - Consults - Councels

- Control - Involves - Coaches
- Make all - Seeks inputs - Shares decisions
process
 Implementing TQM

Organizational Culture
- Ways of thinking
- Attitude
- Norm and behavior
Technical aspect of TQM
- concepts, tools & techniques
Organizational Strategy
- Vision
- Common direction
- motivation
Organizational Structure & infrastructure
- Distribution of authority & responsibility
- Information & reporting systems
 FOCUS PDCA (Hospital Corp Of America)

Find a process to Plan : improvement,

improve data collection

Organize a team that Do : Improvement,

know the process data collection, data
Clarity current analisis
knowledge of the
process
Check : data for
process improvement
Understanding causes and customer outcome
of process variation lessons learned
Select the process Act : the hold gain, to
improvement reconsider owner to
continue improvement
 QA CQI

Implement

plan DO

Standadize Study

Improvement

Act Check
The Approach of TQM Pilot Project
Introduce change : Enhance TQM
Practice :
* TQM / CQI * TQM / CQI
For exec, * ESB Indicators
* AIC Measurement
DO
Few Selected
Process

Attitude Behaviour Process Result

Re Orientation : ReInforce TQM RS Kelas B

5S Quality Hospital Policy Pendidikan
SS (BLUD)
QCC
Key success factors / obstacles
1. Partisipation of everyone
2. Commitment & support from the executive
3. Knowledge & Understanding of TQM / CQI
4. Motivation / incentives
5. Coordination / Communication
6. Resources

Autonomization Privat owner

Control
Government Control Organization
Coordination