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
Personal Needs Experiences
Communication

Expected Services

Gap 1
Perceived Services

External
Communication 4
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

Yes No
Produced
Service
Acceptable to Acceptable to Satisfied
Product No provider Costomer Customer
Or
Information
No
Rework Cost
effective Waste
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
Test performed by
the diagnostic Results of test
the 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 &
Planning and Design costs

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

= Customer oriented,
Quality
Not provider
Not doctor
Not Management Oriented

= Managing Process with data

Managemen
t
 Process
Orientation
Customer
Focus Leadership

Common
Vision Worker
empowerment

TQM
Quality
First Education
a training

Manajemen Cross
by fact function
team work

Learning &
continous
Supplier
improvemen
partnership
t
 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
Awarcness and TQM / CQI
commitmen Top Managemen Comitment

Phase 2 Perform internal quality assesment provide

Planning education to 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
Kubler Ros o. Communication &
support
1. Denial and isolation 2. Anger
o. Including people
2. Anger in planning
3. Resistance
3. Bargaining o. Training & support
4. Exploration
4. Deppression o. Tool, tecnique &
time
5. Acceptance 5. Commitment
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
Quality Control Circles = team work to
QCC contribute to improvement

ISO 9001 = Quality Management System

ISO 14001 =
ISO
ISO 18001 =
Total Produktive Maintenance.

TPM

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, data
improve collection
Organize a team Do : Improvement,
that know the
data collection, data
process
analisis
Clarity current
knowledge of the Check : data for
process process
Understanding improvement and
customer outcome
causes of process
lessons learned
variation
Select the process Act : the hold gain,
improvement to 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
Control

Governmen Organizatio
Coordination
t n