In general, the philosophical elements of CQI refer to the minimum aspects of quality improvement that must be present in an organization for it to claim that it is undertaking continuous quality improvement. These elements include strategic focus, customer focus, systems view, data-driven (evidence-based) analysis, implementer involvement, multiple causation, solution identification, process optimization, continuing improvement, and organizational learning (Sollecito & Johnson, 2011). The philosophical elements of CQI can be applied to a health care setting in a variety of ways. For instance, strategic focus is a beneficial element of CQI because it emphasizes on aligning the health care organization’s mission, values, and objectives to ensure that various performance improvement processes are well designed, prioritized, and implemented for the purpose of supporting quality improvement.
Moreover, experts recommend that customer focus is a vital element of CQI, which must be present in any health care organization. Crucial role of the customer focus is explained by the need to mark customer satisfaction and health outcomes as the major performance measures. Here, it is important to note that a “customer” in a health care setting refers to the patient, health care provider, a funder, other health care organizations, a payer, or a colleague (Kahan & Goodstadt, 1999). Therefore, a CQI project should begin by ascertaining the customer’s needs and preferences through consumer surveys, focus groups, and interviews. Another important element of CQI that should be applied to health care involves data-driven (evidence-based) analysis of the operation and performance systems. According to Sollecito and Johnson (2011), evidence-based medicine and management in the health care organization involves identification and implementation of the best clinical and management practices by utilizing a wide range of professional literature and the internal resources or experiences. More so, the overall objective of CQI in health care should be aimed at solution identification. Here, the CQI project should seek to develop a set of solutions that can help the organization implement system-wide performance and quality improvement.
As opposed to the philosophical elements described in the foregoing discussions, structural elements of CQI are used in structuring, organizing, and supporting the process of continuous improvement. These elements include process improvement teams, the seven CQI tools, parallel organization, organizational leadership, statistical analysis, customer satisfaction measures, benchmarking, and redesigning of internal processes from scratch (Sollecito & Johnson, 2011). And just like the philosophical elements, various structural elements of CQI can be applied to a health care setting in different ways. For example, process improvement teams form the core of CQI because team approach is more effective in analyzing and dealing with problems and opportunities as opposed to individual effort. Therefore, in a healthcare setting whereby quality and safety are central to performance improvement and customer satisfaction, it is imperative to employ teams of key stakeholders in advancing the objectives of a CQI initiative. Most importantly, Kahan and Goodstadt (1999) indicate that team approach in CQI can be very effective in health promotion, especially in the presence of support from the top management and worker involvement or commitment.
On the other hand, when it comes to implementing evidence-based medicine and management, the seven CQI tools are very important. These tools include cause-and-effect diagrams, regression analyses, run charts, flowcharts, histograms, control charts, and Pareto charts. The importance of these tools is that they provide a wide range of tested and approved health-related quality literature. In addition, statistical analysis goes hand-in-hand with these tools because it is very important for the health care organization to use current statistics and statistical process controls to identify and eliminate unnecessary risks during the process of implementing the CQI initiative. On the other hand, parallel organization is a beneficial element of CQI since it allows the organization developing a separate management structure (a quality council) to oversee the implementation and monitoring of the CQI initiative. Overall, a CQI project cannot be complete without organizational leadership considering that leadership is required to make the process of CQI implementation as effective as possible (Sollecito & Johnson, 2011).
The founders of Total Quality Management (TQM) have put forth a variety of philosophies that have informed the development and evolution of quality improvement in different sectors. Among the most respected pioneers of TQM is Walter Shewhart who invented the control charts, which form part of the structural elements of CQI described in the foregoing discussions. These charts are very important to quality improvement as they enable quality control managers to identify and track numerous variations within the organization’s quality improvement project. Moreover, Shewhart is well known for developing the PDSA (plan, do, study, and act) cycle, which is a tested scientific method in the implementation of TQM. Another pioneer of TQM is Edwards Deming who is reputed for having developed a number of courses during World War II with the intention of teaching quality control techniques to military engineers and executives. Moreover, he continued teaching courses on statistical quality control to personnel in different Japanese industrial companies after the war (Sollecito & Johnson, 2011).
Further, Philip Crosby is another important founder of TQM who has made a variety of contributions, including emphasizing that the cost of poor quality is much greater than the cost incurred in preventing poor quality. In addition, Crosby identified and defined conformance to requirements, prevention, and zero defects as the central aspects in TQM. On the other hand, Dr. Joseph Juran is well known for writing The Quality Control Handbook, which has been recognized as an important literature resource for engineers in most industrial companies. He also introduced the human aspect into quality management by emphasizing the involvement of top management and widespread training of personnel for the purpose of quality improvement. Dr. Juran is also best known for introducing the Pareto principle to quality management. Lastly, Armand Feigenbaum is another important pioneer of TQM who is well known for developing the concept of Total Quality Control, which later evolved into TQM. His other contributions include the development of accountability in quality management, the concept of a “hidden” plant, and his emphasis on TQM’s effectiveness in promoting quality development, quality improvement, and quality maintenance, and ensuring customer satisfaction (Sollecito & Johnson, 2011).