Quality Tools

Tools were always viewed as physical objects, a hammer, screwdriver etc but the concept can be extended to cover the new ideas of using tools for improving your methods of working.

As I hear of ideas or develop new ways of using tools these will be added to this section. Your contributions would be greatly appreciated, so we hope to hear from you.

Benchmarking

Feedback:

Feedback is about doing things better by reflecting on both what has gone well and what has been a problem.

It is an evolutionary process in which small incremental changes add up to major improvements over a period of time.A stable feedback system has both positive and negative inputs. The original theory relates to electronics and the ability of a radar controlled gun to follow an aircraft.

When used as a management tool the importance of balancing the positive and negative is paramount. So often the only memory juniors have of appraisal is the negative one of being reprimanded when things go wrong. This results is an avoidance response. That is why any difficult or risky situations are avoided.

Always be clear as to your intended output as the feedback is dependant on where you want to go.

Pareto's Principal: Pareto & The Analysis of Problems

I think that this is one of the most useful tools in the real life analysis of problems. We'll give just a little background first.

Pareto was an Italian / Swiss economist at the turn of the 19th century. His early work was on equilibrium and he came to try and apply this to incomes and economics. What he is now remembered for is the Pareto Principle which strangely enough seems to cover a vast array of subjects.

Basically the principle is that when you look at any system then 80% of problems are caused by just 20% of reasons. The converse is true that the other 20% of problems are caused by 80% of reasons. It is really a very handy tool in focussing attention on the areas that really matter. When starting on a new project it is best first to do a Pareto analysis so that when you pick a subject to work on the payoff is huge. A typical graph might look something like this:

Pareto graphs are really easy to do. First of all you need to collect data. A good source is to ask everyone to jot down on a sheet any problems that arise even quite minor things. The sheets are collected after say a week and the problems analysed. Quite a nice source of medical problems are the MDU reports which give an analysis of complaints against doctors.

Then put the data on Excel, start the graph section up and go to ‘Custom Types’ then ‘Line – Column’. It is quite straight forward .

There are a number of Web Sites about both Pareto himself and the applications: The University of Melbourne & Robert Luttman & Associates

Poka – Yoke & Being Right by Design: If something can go wrong then it will ! That's the first law of the universe.

Poka - Yoke is not about stopping mistakes happening completely but rather if you can anticipate that mistakes will happen or by Pareto analysis identify what mistakes do happen then why not do something about them. It was invented by Shigeo Shingo in the 1960s and means "poka" = inadvertent mistake, "yoke" = prevent. A simple concept you might think and one that is eminently suited to medicine where mistakes are very easy to make and can be catastrophic.

There are two areas to the process:
1. Design your equipment, system, training etc so that it is obvious how it should be used and make it so that it is well nigh impossible to do it the wrong way. Years ago I used to be an anaesthetist and they had systems like this. The Oxygen bottle and the pipe that went to it had pins which prevented you connecting the wrong bottle to the O2. Even when this is done the second aspect needs to come in.

2. When things go wrong you need to be have a warning arrangement so that if anything other than O2 comes through the pipe then a buzzer sounds. At the same time an Oxymeter connected to the patient should give you the blood oxygen level.

One only has to read the reports from the MDU to see that the same mistakes keep happening. This tool seems to offer one of the most obvious ways of reducing problems which are unpleasant if no down right lethal.

Schewart's System:

Schewart was one of the early innovators in developing scientific methods for manufacturing products. His concept of planning how you are going to do something, doing it and the checking and looking for improvements is difficult to better.

It is usually represented in a loop format with the idea of repeated improvement as you go round the system.

This all ties in with group dynamics and human evolution. It is about tapping into the will to do something together which is greater than any individual could achieve.