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OATSIH Accreditation Manual

1.9 Continuous Quality ImprovementThis chapter refers to the Continuous Quality Improvement tool for improving quality of services provided by organisations.

Page last updated: 07 September 2012

Continuous quality improvement is a tool for improving the quality of services provided by organisations. Continuous quality improvement refers to having a systematic approach to

collecting and reviewing data or information in order to identify opportunities to improve the operations of an organisation with the end result of delivering better services to customers or clients.

Most current standards frameworks, including those relevant to ACCHOs, require organisations to demonstrate that they have implemented processes to continuously improve their operations and the quality of services to clients. Most organisations are always improving in response to people’s ideas on how to do things better. The drawback is that improvements are often ad-hoc, not monitored and rarely evaluated to check that they really did result in improvements to clients, the staff and the organisation as a whole.

Continuous quality improvement is a managed approach to quality improvement that emphasises an ongoing or continual process of improvement and evaluation. The process involves:

Identifying improvements Implementing the improvements Evaluating the effect of improvements and Going back to identify more improvements.

A common approach to continuous quality improvement is to see it as an ongoing cycle involving planning, doing, checking, identifying more actions and then starting again. This is the Plan, Do, Check, Act Cycle shown below.

Figure 1.1: The Plan, Do, Check, Act Cycle

Top of page

Plan:

Clarify issues or problems Collect and review data or other information related to the issues or problems Identify the causes of the issue or problem Clearly identify improvements that can be made Clarify the outcomes for improvements Develop strategies to implement improvements—consider stakeholders—consider

strategies to get management support Identify how you will measure the success of the improvement and identify how you

will collect the data Identify key tasks

Do:

Gain approval for improvements Implement the improvements— assign key tasks Monitor the implementation—make sure key tasks are completed Collect data on improvements

Check:

Did the improvement work? If not, why not? Were there any unintended consequences? Collect ongoing data on the operations of your organisation—e.g. client feedback,

staff feedback, accident/incident reports, hazard reports, audits, etc.—what does this tell us about the improvements?

Act:

Consider improvements—do they suggest other improvements—e.g. staff training, review of procedures, changes to organisation operations?

If improvements did not work what do we need to do? If there were unintended consequences to improvements—do we need to do anything

about them? Consider new data—e.g. client feedback, staff feedback, accident/ incident reports,

hazard reports, audits, etc—does it suggest improvements? Look for things to improve—look at problems and consider solutions.

The commitment to improvement needs to be ongoing. It needs to be built into the organisation’s culture and practice to ensure the organisation continues to change and adapt to the needs of its clients. Top of page

Case Study 1: Practice Manager, Victoria

I am the Practice Manager of a bustling ACCHO with 25 full-time staff in rural Victoria. In addition to general medical services, we also provide programs including Drug and Alcohol

and ‘Bringing them Home’, a HACC program and a Regional Hearing Program. We were first accredited in 2006 and are up for renewal in 2009.

Early in the process, most of the staff that were involved moved on, so we had to get the standards out and get our EQHS facilitator involved in the process. This involved a number of sessions where we looked at what each standard was, what the gaps were and what to do to fill in the gaps. It really was a case of looking at the resulting action plan and looking at the organisational profile—we actually didn’t want to tack things on. We understood that we needed to change the ‘culture of the organisation’. It needed to be done on a day to day basis—it needed to be built into the system.

Accreditation is a time-consuming process, and it is not easy to fulfil the role of coordinating accreditation on top of other responsibilities. I got through it with EQHS facilitator support, and for our next accreditation I would possibly be able to manage it alongside all my other duties without the support, simply because we now have the processes in place to ensure that the entire organisation participates and is accountable.

Ideally it would be good to have someone to primarily deal with accreditation, but they would need to be a long term staff member. Initially, this must be to change the culture, but once that happens, everyone owns it.

In the beginning there were some difficulties. Alongside the first initial review there were delays in getting the funding and this caused a few headaches. However, the EQHS facilitator gave us an action plan to differentiate between the things that could be achieved short-term in house, and those that needed to consider the ‘red tape’.

It was also difficult with staff. Speaking to them they said they found it hard to make the changes because they were not seeing anything happen, due to the ‘limbo’ time lag. The way we overcame this was to implement an accreditation review committee which meets fortnightly. We also implemented training and mentoring with all staff.

It is so important to keep communications open with all staff, simply because if they aren’t aware of the process and the impact, they will not stay in the loop. An organisation must evaluate and audit all RACGP related issues and processes on a regular basis.

The first time around accreditation can be a daunting process, but with good management and an overall commitment to the process, it gets easier.

EQHS facilitator support (I could not have done without this the first time) was so valuable in the early days, as they have a lot of resources and expertise, and once you have a monthly action plan in place to follow, it is a straightforward process.

If we were to do it differently

I would say that you cannot involve staff enough! Get them to ‘OWN’ the process a bit more. We have redone our position descriptions—so that all staff participate in the whole process of standards and the requirements.

Accreditation is so important as all staff become part of the organisation—it is not just an

add-on after-thought; it becomes part of all the processes in the organisation. It is all about improving the organisation and providing a quality service.

If we were to give advice, I would say:

Accreditation should be embraced—it allows so much to be achieved—systems, policies and procedures. As an example: with play equipment—what safety procedures are in place? What about cleaning? Who does the cleaning? Does it need to be put onto the maintenance forms?

It changes the whole culture of the organisation. Who needs to sign off? Who needs to be responsible? For every part of an organisation, these questions have to be asked.

Accreditation has really increased and strengthened our team and provided a high quality organisation that delivers a high quality service to all our clients. Top of page

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Table of contents Preface Abbreviations Section1: Terms and definitions

o 1.1 Establishing Quality Health Standards (EQHS) 1 o 1.2 Standards o 1.3 Quality o 1.4 Quality Management System o 1.5 Good Practice and Best Practice o 1.6 Accreditation and Certification o 1.7 Accreditation and the OATSIH Risk Assessment Process o 1.8 Australian Commission on Safety and Quality in Health Care — Proposed

Standardso 1.9 Continuous Quality Improvement

Section 2: Standards and Frameworks o 2.1 Royal Australian College of General Practitioners Standards o 2.2 Quality Improvement Council Standards 16 o 2.3 Australian Council on HealthCare Standards (ACHS) o 2.4 International Organisation for Standardization AS/NZS 9001:2008 Quality

Management Systems—Requirementso 2.5 Choosing a Standards Framework

Section 3: Key Stakeholders o 3.1 OATSIH National Quality Network 21 o 3.2 Aboriginal Community Controlled Health Organisations o 3.3 ACCHO Board o 3.4 ACCHO Manager o 3.5 ACCHO Staff o 3.6 ACCHO Clients

o 3.7 Referral Agencies o 3.8 Funding Providers o 3.9 OATSIH EQHS Quality Improvement and Accreditation Facilitators o 3.10 NACCHO o 3.11 NACCHO Affiliates o 3.12 The Standards Agencies o 3.13 The Assessing Agencies o 3.14 Accreditation Assessors o 3.15 OATSIH Central Office o 3.16 OATSIH State and Territory Project Officers

Section 4: Accreditation o 4.1 Getting Started. o 4.2 Accreditation Readiness Work o 4.3 The accreditation assessment o 4.4 Options for Accreditation o 4.5 Checklist for Preparing for Accreditation o Case Study 4: Goondir Aboriginal and Torres Strait Islander Corporation for

Health Services in QLD, Dual Accreditation—AGPAL and QIC Section 5: Frequently asked questions Section 6: Resources and other information

o 6.1 Interpretive Guides to the QIC and RACGP Standards o 6.2 Aboriginal Health and Medical Research Council of New South Wales

(AH&MRC) Toolkito 6.3 Practice Incentives Program (PIP) o 6.4 Service Incentive Payments (SIP) o 6.5 Indigenous Chronic Disease Package o 6.6 Example Policy and Procedure Manuals

Section 7: Key Contacts Attachments

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Quality Improvement Plan Template

Template in Microsoft Word

This template can be downloaded in Microsoft Word format. If you experience difficulty accessing the Word version, or require a different format or other support, please call OMH at (518) 474-6587 Monday through Friday, 9:00 a.m. to 5:00 p.m.

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New York State Office of Mental HealthOffice of Quality Management2005

Quality Improvement PlanName of Clinic

Date of the Current Plan

Section 1 – Introduction

Introduction: Mission, Vision, Scope of Service(Describe briefly the clinic program that will be covered by this Plan, including the clinic’s mission and vision, the types of services provided, its relative size, etc,)

The following Quality Improvement Plan serves as the foundation of the commitment of the this clinic to continuously improve the quality of the treatment and services it provides.

Quality.Quality services are services that are provided in a safe, effective, recipient-centered, timely, equitable, and recovery-oriented fashion.

( Clinic name ) is committed to the ongoing improvement of the quality of care its consumers receive, as evidenced by the outcomes of that care.  The organization continuously strives to ensure that:

The treatment provided incorporates evidence based, effective practices; The treatment and services are appropriate to each consumer’s needs, and available

when needed; Risk to consumers, providers and others is minimized, and errors in the delivery of

services are prevented; Consumers’ individual needs and expectations are respected; consumers – or those

whom they designate – have the opportunity to participate in decisions regarding their treatment; and services are provided with sensitivity and caring;

Procedures, treatments and services are provided in a timely and efficient manner, with appropriate coordination and continuity across all phases of care and all providers of care.

Quality Improvement Principles.Quality improvement is a systematic approach to assessing services and improving them on a priority basis.  The (Name of Clinic)  approach to quality improvement is based on the following principles:

Customer Focus.  High quality organizations focus on their internal and external customers and on meeting or exceeding needs and expectations.

Recovery-oriented.  Services are characterized by a commitment to promoting and preserving wellness and to expanding choice. This approach promotes maximum flexibility and choice to meet individually defined goals and to permit person-centered services.

Employee Empowerment.   Effective programs involve people at all levels of the organization in improving quality.

Leadership Involvement.   Strong leadership, direction  and support of quality improvement activities by the governing body and CEO are key to performance improvement.  This involvement of organizational leadership assures that quality improvement initiatives are consistent with provider mission and/or strategic plan.

Data Informed Practice. Successful QI processes create feedback loops, using data to inform practice and measure results. Fact-based decisions are likely to be correct decisions.

Statistical Tools. For continuous improvement of care, tools and methods are needed that foster knowledge and understanding. CQI organizations use a defined set of analytic tools such as run charts, cause and effect diagrams, flowcharts, Pareto charts, histograms, and control charts to turn data into information.

Prevention Over Correction.  Continuous Quality Improvement entities seek to design good processes to achieve excellent outcomes rather than fix processes after the fact.

Continuous Improvement.  Processes must be continually reviewed and improved.  Small incremental changes do make an impact, and providers can almost always find an opportunity to make things better.

Continuous Quality Improvement Activities.Quality improvement activities emerge from a systematic and organized framework for improvement.  This framework, adopted by the hospital leadership, is understood, accepted and utilized throughout the organization, as a result of continuous education and involvement of staff at all levels in performance improvement. Quality Improvement involves two primary activities:

Measuring and assessing the performance of clinic services through the collection and analysis of data.

Conducting quality improvement initiatives and taking action where indicated, including the

o design of new services, and/or     o improvement of existing services.

The tools used to conduct these activities are described in Appendix A, at the end of this Plan.

Section 2 – Leadership and Organization

Leadership.The key to the success of the Continuous Quality Improvement process is leadership.  The following describes how the leaders of the (Name of Clinic) clinic provide support to quality improvement activities.

The Quality Improvement Committee provides ongoing operational leadership of continuous quality improvement activities at the clinic. It meets at least monthly or not less than ten (10) times per year and consists of the following individuals:  (List titles of committee members. The membership should include a recipient/family member for adult settings and a family member for children settings. Indicate the Chairperson of the Committee.)

The responsibilities of the Committee include:

Developing and approving the Quality Improvement Plan. As part of the Plan, establishing measurable objectives based upon priorities identified

through the use of established criteria  for improving the quality and safety of clinic services.

Developing indicators of quality on a priority basis.  Periodically assessing information based on the indicators, taking action as evidenced

through quality improvement initiatives to solve problems and pursue opportunities to improve quality.

Establishing and supporting specific quality improvement initiatives.          Reporting to the Board of Directors on quality improvement activities of the clinic on

a regular basis. Formally adopting a specific approach to Continuous Quality Improvement  (such as

Plan-Do-Check-Act: PDCA).

The Board of Directors also provides leadership for the Quality Improvement process as follows:

Supporting and guiding implementation of quality improvement activities at the clinic.

Reviewing, evaluating and approving the Quality Improvement Plan annually.

(Describe how leadership will support clinic’s QI Program.)

The Leaders support QI activities through the planned coordination and communication of the results of measurement activities related to QI initiatives and overall efforts to continually improve the quality of care provided. This sharing of QI data and information is an important leadership function.  Leaders, through a planned and shared communication approach, ensure the Board of Directors, staff, recipients and family members have knowledge of and input into ongoing QI initiatives as a means of continually improving performance.

This planned communication may take place through the following methods;          

Story boards and/or posters displayed in common areas Recipients participating in QI Committee reporting back to recipient groups Sharing of the clinic’s annual QI Plan evaluation Newsletters and or handouts

Please describe your clinics method and/or mechanism for communication to recipients, staff and leadership.

Section 3 – Goals and Objectives

The Quality Improvement Committee identifies and defines goals and specific objectives to be accomplished each year.  These goals include training of clinical and administrative staff regarding both continuous quality improvement principles and specific quality improvement initiative(s).  Progress in meeting these goals and objectives is an important part of the annual evaluation of quality improvement activities.

The following are the ongoing long term goals for the   (Name of Clinic)  QI Program and the specific objectives for accomplishing these goals for the year ______ . (Indicate the current year.)

To implement quantitative measurement to assess key processes or outcomes; (An example of an objective involving quantitative measurement: The average number of “no shows” will be reduced overall by 30% from its current average of ______ within the next 12 months.)

To bring managers, clinicians, and staff together to review quantitative data and major clinical adverse occurrences to identify problems;

To carefully prioritize identified problems and set goals for their resolution; To achieve measurable improvement in the highest priority areas; To meet internal and external reporting requirements; To provide education and training to managers, clinicians, and staff;  (An example of

an objective involving education and training; 100% of all managers, clinicians, and staff will be trained in the principles and practices of Quality Improvement by   date   .)  

To develop or adopt necessary tools, such as practice guidelines, consumer surveys and quality indicators.

List here your goals and objectives for the current year.  Selection of your goals may be taken from the list provided above.  You do not need to select all of these goals.  The list should be tailored to your program and include specific objectives - ways in which these goals will be accomplished. The objective(s) for each of your selected goals need to be specific and measurable.  Specific and measurable means that you will be able to clearly determine whether the objectives have been met at the end of the year by using a specified set of QI tools.  (See Appendix A.)  At least one of the goals and its corresponding objective(s) should concern staff education related to your quality improvement activities.

Section 4 – Performance Measurement

Performance Measurement is the process of regularly assessing the results produced by the program.  It involves identifying processes, systems and outcomes that are integral to the performance of the service delivery system, selecting indicators of these processes, systems and outcomes, and analyzing information related to these indicators on a regular basis.  Continuous Quality Improvement involves taking action as needed based on the results of the data analysis and the opportunities for performance they identify.

The purpose of measurement and assessment is to:

Assess the stability of processes or outcomes to determine whether there is an undesirable degree of variation or a failure to perform at an expected level.

Identify problems and opportunities to improve the performance of processes. Assess the outcome of the care provided. Assess whether a new or improved process meets performance expectations.

Measurement and assessment involves:

Selection of a process or outcome to be measured, on a priority basis.

Identification and/or development of performance indicators for the selected process or outcome to be measured.

Aggregating data so that it is summarized and quantified to measure a process or outcome.

Assessment of performance with regard to these indicators at planned and regular intervals.

Taking action to address performance discrepancies when indicators indicate that a process is not stable, is not performing at an expected level or represents an opportunity for quality improvement.

Reporting within the organization on findings, conclusions and actions taken as a result of performance assessment.

Selection of a Performance Indicator.A performance indicator is a quantitative tool that provides information about the performance of a clinic’s process, services, functions or outcomes.  Selection of a Performance Indicator is based on the following considerations:

Relevance to mission - whether the indicator addresses the population served Clinical importance - whether it addresses a clinically important process that is:

o high volumeo problem prone oro high risk

Characteristics of a Performance Indicator.Factors to consider in determining which indicator to use include;

Scientific Foundation: the relationship between the indicator and the process, system or clinical outcome being measured

Validity: whether the indicator assesses what it purports to assess Resource Availability: the relationship of the results of the indicator to the cost

involved and the staffing resources that are available Consumer Preferences: the extent to which the indicator takes into account individual

or group (e.g., racial, ethnic, or cultural) preferences Meaningfulness: whether the results of the indicator can be easily understood, the

indicator measures a variable over which the program has some control, and the variable is likely to be changed by reasonable quality improvement efforts.

(Describe the factors which you will consider in selecting a measure of quality.)  

The Performance Indicator Selected for the (Name of Clinic) Quality Improvement Plan.For purposes of this plan, an indicator(s) comprises five key elements: name, definition, data to be collected, the frequency of analysis or assessment, and preliminary ideas for

improvement.  The following Table presents each performance indicator currently in use by the clinic, along with the corresponding descriptors.

Measure of Service Quality (Complete this table for each indicator which is selected.  Note that only one indicator is required during the first year of the agreement.)

Name Name.  Usually a brief two or three word title.

Definition Definition.  With detail, explain the name by including the data elements and the type of numerical value to be used to express the indicator (percentage, rate, number of occurrences etc.).

Data Collection Describe how the data will be collected as well as the method and frequency of collection, and who will collect the data.

Assessment Frequency

State how often the Quality Improvement Committee will assess information associated with the indicator.

Assessment.Assessment is accomplished by comparing actual performance on an indicator with:

Self over time. Pre-established standards, goals or expected levels of performance. Information concerning evidence based practices. Other clinics or similar service providers.

(List here the assessment strategies you will use.  See APPENDIX A, attached, for examples of performance improvement tools.)

Section 5 – Quality Improvement Initiative

Once the performance of a selected process has been measured, assessed and analyzed, the information gathered  by the above performance indicator(s) is used to identify a continuous quality improvement initiative to be undertaken. The decision to undertake the initiative is based upon clinic priorities. The purpose of an initiative is to improve the performance of existing services or to design new ones.  The model utilized at  Name of Clinic  is called Plan-Do-Check-Act (PDCA).  (Modify the following as appropriate for your program.  If you choose a model other than PDCA, describe the model here.)

Plan - The first step involves identifying preliminary opportunities for improvement.  At this point the focus is to analyze data to identify concerns and to determine anticipated outcomes.  Ideas for improving processes are identified. This step requires the most time and effort.  Affected staff or people served are identified, data compiled, and solutions proposed. (For tools used during the planning stage, see sections “a” thru “k” in APPENDIX: A. )

Do - This step involves using the proposed solution, and if it proves successful, as determined through measuring and assessing, implementing the solution usually on a trial basis as a new part of the process.             

Check -  At this stage, data is again collected to compare the results of the new process with those of the previous one.            

Act - This stage involves making the changes a routine part of the targeted activity.  It also means “Acting” to involve others (other staff, program components or consumers) - those who will be affected by the changes, those whose cooperation is needed to implement the changes on a larger scale, and those who may benefit from what has been learned.  Finally, it means documenting and reporting findings and follow up.

Section 6 – Evaluation

An evaluation is completed at the end of each calendar year. The annual evaluation is conducted by the clinic and kept on file in the clinic, along with the Quality Improvement Plan.  These documents will be reviewed by the Office of Mental Health as part of the clinic certification process.

The evaluation summarizes the goals and objectives of the clinic’s Quality Improvement Plan, the quality improvement activities conducted during the past year, including the targeted process, systems and outcomes, the performance indicators utilized, the findings of the measurement, data aggregation, assessment and analysis processes, and the quality improvement initiatives taken in response to the findings.

Summarize the progress towards meeting the Annual Goals/Objectives. For each of the goals, include a brief summary of progress including progress in

relation to training goal(s). Provide a brief summary of the findings for each of the indicators you used during the

year. These summaries should include both the outcomes of the measurement process and the conclusions and actions taken in response to these outcomes. Summarize your progress in relation to your Quality Initiative(s). For each initiative, provide a brief description of what activities took place including the results on your indicator.  What are the next steps?  How will you “hold the gains.”  Describe any implications of the quality improvement process for actions to be taken regarding outcomes, systems or outcomes at your program in the coming year.)

Recommendations: Based upon the evaluation, state the actions you see as necessary to improve the effectiveness of the QI Plan.  

Appendix A.  Quality Improvement Tools 

Following are some of the tools available to assist in the Quality Improvement process.

1. Flow Charting:  Use of a diagram in which graphic symbols depict the nature and flow of the steps in a process.  This tool is particularly useful in the early stages of a project to help the team understand how the process currently works.  The “as-is” flow chart may be compared to how the process is intended to work.  At the end of the project, the team may want to then re-plot the modified process to show how the redefined process should occur.  The benefits of a flow chart are that it:

1. Is a pictorial representation that promotes understanding of the process2. Is a potential training tool for employees3. Clearly shows where problem areas and processes for improvement are.

Flow charting allows the team to identify the actual flow-of-event sequence in a process.

2. Brainstorming:  A tool used by teams to bring out the ideas of each individual and present them in an orderly fashion to the rest of the team.  Essential to brainstorming is to provide an environment free of criticism.  Team members generate issues and agree to “defer judgement” on the relative value of each idea.  Brainstorming is used when one wants to generate a large number of ideas about issues to tackle, possible causes, approaches to use, or actions to take.  The advantages of brainstorming are that it:

1. Encourages creativity2. Rapidly produces a large number of ideas3. Equalizes involvement by all team members4. Fosters a sense of ownership in the final decision as all members actively

participate5. Provides input to other tools: “brain stormed” ideas can be put into an affinity

diagram or they can be reduced by multi-voting.3. Decision-making Tools:  While not all decisions are made by teams, two tools can

be helpful when teams need to make decisions. 1. Multi-voting is a group decision-making technique used to reduce a long list

of items to a manageable number by means of a structured series of votes.  The result is a short list identifying what is important to the team.  Multi-voting is used to reduce a long list of ideas and assign priorities quickly with a high degree of team agreement.

2. Nominal Group technique-used to identify and rank issues.4. Affinity Diagram:  The Affinity Diagram is often used to group ideas generated by

brainstorming.  It is a tool that gathers large amounts of language data (ideas, issues, opinions) and organizes them into groupings based on their natural relationship.  The affinity process is a good way to get people who work on a creative level to address difficult, confusing, unknown or disorganized issues.  The affinity process is formalized in a graphic representation called an affinity diagram.This process is useful to:

1. Sift through large volumes of data.2. Encourage new patterns of thinking.

As a rule of thumb, if less than 15 items of information have been identified, the affinity process is not needed.

5. Cause and Effect Diagram(also called a fishbone or Ishakawa diagram):  This is a tool that helps identify, sort, and display.  It is a graphic representation of the relationship between a given outcome and all the factors that influence the outcome.  This tool helps to identify the basic root causes of a problem.  The structure of the diagram helps team members think in a very systematic way.  The benefits of a cause-and-effect diagram are that it:

1. Helps the team to determine the root causes of a problem or quality characteristic using a structured approach

2. Encourages group participation and utilizes group knowledge of the process3. Uses an orderly, easy-to-read format to diagram cause-and-effect relationships4. Indicates possible causes of variation in a process5. Increases knowledge of the process6. Identifies areas where data should be collected for additional study.

 Cause and effect diagrams allow the team to identify and graphically display all possible causes related to a process, procedure or system failure.

6. Histogram:  This is a vertical bar chart which depicts the distribution of a data set at a single point in time.  A histogram facilitates the display of a large set of measurements presented in a table, showing where the majority of values fall in a measurement scale and the amount of variation.  The histogram is used in the following situations:

1. To graphically represent a large data set by adding specification limits one can compare;

2. To process results and readily determine if a current process was able to produce positive results assist with decision-making.

7. Pareto Chart:  Named after the Pareto Principle which indicates that 80% of the trouble comes from 20% of the problems.  It is a series of bars on a graph, arranged in descending order of frequency.  The height of each bar reflects the frequency of an item.  Pareto charts are useful throughout the performance improvement process - helping to identify which problems need further study, which causes to address first, and which are the “biggest problems.”  Benefits and advantages include:

1. Focus on most important factors and help to build consensus2. Allows for allocation of limited resources.

  The “Pareto Principle” says 20% of the source causes 80% of the problem. Pareto charts allow the team to graphically focus on the areas and issues where the greatest opportunities to improve performance exist.

8. Run Chart:  Most basic tool to show how a process performs over time.  Data points are plotted in temporal order on a line graph.  Run charts are most effectively used to assess and achieve process stability by graphically depicting signals of variation.  A run chart can help to determine whether or not a process is stable, consistent and predictable.  Simple statistics such as median and range may also be displayed.The run chart is most helpful in:

1. Understanding variation in process performance2. Monitoring process performance over time to detect signals of change3. Depicting how a process performed over time, including variation.

Allows the team to see changes in performance over time.  The diagram can include a trend line to identify possible changes in performance.

9. Control Chart:  A control chart is a statistical tool used to distinguish between variation in a process resulting from common causes and variation resulting from special causes.  It is noted that there is variation in every process, some the result of causes not normally present in the process (special cause variation).  Common cause variation is variation that results simply from the numerous, ever-present differences in the process.  Control charts can help to maintain stability in a process by depicting when a process may be affected by special causes.  The consistency of a process is usually characterized by showing if data fall within control limits based on plus or minus specific standard deviations from the center line.  Control charts are used to:

1. Monitor process variation over time2. Help to differentiate between special and common cause variation 3. Assess the effectiveness of change on a process4. Illustrate how a process performed during a specific period.

Using upper control limits (UCLs) and lower control limits (LCLs) that are statistically computed, the team can identify statistically significant changes in performance. This information can be used to identify opportunities to improve performance or measure the effectiveness of a change in a process, procedure, or system.

10. Bench Marking:  A benchmark is a point of reference by which something can be measured, compared, or judged.  It can be an industry standard against which a program indicator is monitored and found to be above, below or comparable to the benchmark.

11. Root Cause Analysis:  A root cause analysis is a systematic process for identifying the most basic factors/causes that underlie variation in performance.

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Process Improvement Approaches

Realizing improvements within your organization works best with a structured approach that enables a team of 3 - 8 people involved in and knowledgeable about the process to focus on a problem and quickly generate solutions. Whatever approach is used, adhering to key principles such as obtaining leadership commitment beforehand, limiting the number and length of meetings by accomplishing detailed tasks outside of formal meeting time, and compressing the overall timeframe for the project by working on multiple tasks simultaneously, will help ensure the success of the team's efforts.

A proven approach referred to as "Accelerated Improvement" includes systematic advanced planning, clear goals and measures of progress, and actionable and prioritized solutions. The Accelerated Improvement Guide discusses the approach in detail, with instructions for completing the following steps:

Initiate project Design solutions Implement solutions Demonstrate impact

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http://www.in.gov/isdh/files/Quality_Improvement_Process_Using_PDSA_Presentation.pdf

Do, Study, Act (PDSA)

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Plan, Do, Study, Act (PDSA)

What is it and how can it help me?

You can use plan, do, study, act (PDSA) cycles to test an idea by temporarily trialling a change and assessing its impact. This approach is unusual in a healthcare setting because traditionally, new ideas are often introduced without sufficient testing.

The four stages of the PDSA cycle: Plan - the change to be tested or implemented Do - carry out the test or change Study - data before and after the change and reflect on what was learned Act - plan the next change cycle or full implementation

When does it work best?

You may not get the results you expect when making changes to your processes, so it is safer, and more effective to test out improvements on a small scale before implementing them across the board.

Using PDSA cycles enables you to test out changes before wholesale implementation and gives stakeholders the opportunity to see if the proposed change will work.

Using the PDSA cycle involves testing new change ideas on a small scale. For example:

Trying out a new way to make appointments for one consultant or one clinic Trying out a new patient information sheet with a selected group of patients before

introducing the change to all clinics or patient groups By building on the learning from these test cycles in a structured way, you can put a

new idea in place with greater chances of success  

As with any change, ownership is key to implementing the improvement successfully. If you involve a range of colleagues in trying something out on a small scale before it is fully operational, you will reduce the barriers to change.

Why test change before implementing it?

It involves less time, money and risk The process is a powerful tool for learning; from both ideas that work and those that

don't It is safer and less disruptive for patients and staff Because people have been involved in testing and developing the ideas, there is

often less resistance 

How to test:

Plan multiple cycles to test ideas. You can adapt these from the service improvement guide so there is already evidence that the change works

Test on a really small scale. For example, start with one patient or one clinician at one afternoon clinic and increase the numbers as you refine the ideas

Test the proposed change with people who believe in the improvement. Don't try to convert people into accepting the change at this stage

Only implement the idea when you're confident you have considered and tested all the possible ways of achieving the change

How to use it

PDSA cycles form part of the improvement guide, which provides a framework for developing, testing and implementing changes leading to improvement. The model is based in scientific method and moderates the impulse to take immediate action with the wisdom of careful study. The framework includes three key questions and a process for testing change ideas.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The three questions:

1. What are we trying to accomplish? The aims statement 2. How will we know if the change is an improvement? 3. What changes can we make that will result in improvement?

What we trying to accomplish? Teams need to set clear and focused goals. These goals require clinical leadership; they should focus on problems that cause concern, as well as patients and staff.

The aims statement should:

Be consistent with any national goals and relevant to the length of the project Be bold in its aspirations Have clear, measurable targets  

An example of an aims statement from cancer services:Aims: To improve access, speed of diagnosis, speed of starting treatment and patient care of people who are suspected of having bowel cancer.

This will be achieved by:

Introducing booked admissions and appointments. Target: more than 95 per cent of patients

Reducing the time from GP referral to first definitive treatment to less than 15 weeks Ensuring that over 80 per cent of patients are discussed by the multidisciplinary

team  

Concentrate efforts and measurements on key stages of care: GP referral, first out-patient appointment, first diagnostic test and first definitive treatment.

How do we know if the change is an improvement? You will need to measure outcomes, such as reduction in the time a patient has to wait in order to answer this question. If we make a change, this should affect the measures and demonstrate over time whether the change has led to sustainable improvement. The measures in this model are tools for learning and demonstrating improvement, not for judgment.

Each project team should collect data to demonstrate whether changes result in improvement.

You should report improvement progress monthly on time series graphs known as ‘run charts' or statistical process control charts (SPC). See the PJA.

What changes can we make that will result in improvement? There are many potential changes your team could make. However, evidence from scientific literature and previous improvement programmes suggests that there are a small number of changes that are most likely to result in improvement.

The Cancer Service Collaborative has identified twenty eight change principles which they have grouped into four areas that you may find helpful.

1. Connect up the patient journey 2. Develop the team around the patient journey 3. Make the patient and care experience central to every stage of the journey 4. Make sure there is capacity to meet patients' needs at every stage of the journey 

It is possible that there may be several PDSA cycles running sequentially (figure 3), or even simultaneously (figure 4). Sequential cycles are common when the study reveals results which suggest a different approach is needed.

Figure 3

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Simultaneous cycles may occur when the changes are more complex, possibly involving several departments. It is important that you identify any interactions between simultaneous cycles, as a change in method in one cycle may alter the impact of another somewhere else. For example, you are making changes to the way that secretaries process letters, so that they are printed and stuffed into envelopes in a central department. As another part of the project, a PDSA cycle looks at when doctors sign their correspondence and concludes that is should be done in the secretary's office.  Obviously the two solutions conflict.   The cycles in use: Produce a first draft. Check it against this guidance. Make changes. Is it easy to read? Produce another draft and check it with members of your team. Do rapid cycles of testing until it seems easy to read?

Is it right? Produce another draft and check it with colleagues, clinicians, experts, patient support groups. Think about people like secretaries and booking staff. If you have to send it to someone, always give them a deadline.

Is it good for patients? Produce another draft and check it with patients or people in the hospital who are unfamiliar with the topic area.

What next?

Having identified the changes with the greatest benefits, the next stage is to fully implement the change. This will require a stakeholder analysis, full project management programme and benefits realisation programme.

Reference for the Model for Improvement

Langley G.L. Nolan K.M. Nolan T.W. Norman C.L. Provost L.P (2009) The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd Edition). Jossey Bass, San Francisco.

ISBN-10 047019210 ISBN-13 978 0470192412

Additional resources

Websites: Process mapping, analysis and redesign

Institute for Healthcare Improvement website -  improvement models and PDSA cycles:

Background

Process mapping, analysis and redesign :

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PDSA

Another commonly used QI model is the PDSA cycle:

1. PLAN: Plan a change or test of how something works.2. DO: Carry out the plan.3. STUDY: Look at the results. What did you find out?4. ACT: Decide what actions should be taken to improve.

Repeat as needed until the desired goal is achieved

Click here to enlarge PDSA model

As you can see, it’s very similar to the FADE cycle.

PDSA ExampleIssue: Ineffective team meetings that were causing more problems than they would resolve.

Cycle 1PLAN – Took suggestions from group and used the suggestions to plan implementation of changes to improve the meetings effectiveness.

Fewer meetings Follow an agenda Assigning tasks prior to meeting

DO – Documented the process and passed out to group members for commentary and commitment to changes.

STUDY – Group members were worried about their assignments and agenda items to submit, today’s topic may not be the “hot” issue when the meeting was held.

ACT – Decided to proceed with the changes in spite of the concerns due to perception that the concerns were unfounded and based on fear of change.

Cycle 2PLAN – New process initiated but only one topic submitted for agenda.

DO – He created an agenda with one topic and one regarding the lack of agenda items, assigned roles and held the meeting.

STUDY – Meeting was short for the wrong reason. People did not know what format to use when submitting agenda items. Also, concerned about how items would be used.

ACT – A form was created for submitting agenda items. Everyone was assigned to submit one item using the form for the next meeting.

Any further process issues would be addressed in the same manner.

Questions about this website, please email: CFM_Webmaster@mc.duke.edu© 2014 Department of Community and Family Medicine, Duke Univers

http://education-portal.com/academy/lesson/deming-juran-crosby-contributors-to-tqm.html#lesson

W. Edwards Deming, Joseph Juran and Philip B. Crosby are three of the most influential

people involved in the shift from production and consumption to total quality

management (TQM). Their work significantly impacted how industries view customer

satisfaction, employee needs and supplier relations.

TQM And The Men Who Made Us Think About ItTotal quality management (TQM) is an approach to serving customers that involves

totallyreengineering processes and systems to improve products and services in the

way customers expect while considering the needs of employees and relationships with

suppliers. W. Edwards Deming, Joseph Juran and Philip B. Crosby each developed a

different aspect of TQM. We will learn about how each contributed to how we think

about TQM today.

The TQM approach began as a means

of repairing the damage Japan suffered

post-World War II. W. Edwards Deming

worked with Japanese automobile

manufacturers to improve the quality

of their products in an effort to gain a

competitive foot in the industry.

His philosophy resulted in the 14 Points

of TQM, which can be summed up by

saying management must redesign

their processes and systems to:

Plan

Do

Check

Act

Deming's Philosophy On TQM

Deming, Juran and Crosby

Let's see how TQM is implemented at Beefy's Burgers.

To plan, Deming counsels that businesses should design quality products and services

that customers want, develop processes and systems that reduce waste and increase

quality and decrease the cost of production.

Deming wanted to revolutionize the way Beefy's Burgers produces burgers. To gain a

better understanding of the customer preferences, he surveyed everyone involved in

the operation, from the customers to the employees. He even called his suppliers in to

get their opinions. From the information collected, Deming was able to determine a few

important things. Beefy's was competitive on price. However, the burger was small and

flavorless.

He called his employees in and showed them how to properly grill the burgers. He

called his supplier in to discuss alternatives to the current beef he uses. A timing

schedule for completion of burger orders was set. No burger would hit the grill until the

customer placed an order. Tomorrow would be go time!

Next, the businesses must do the work by putting the plan into action. As processes

and systems are running, they must continually seek ways to do things better.

Deming's crew knew exactly what to do. Stations were set up for bun-slicing, burger-

grilling and ketchup-squeezing. As customers placed their orders, the beef hit the grill,

the bun was sliced 1.2 seconds after and delivered to the grill, ketchup was squeezed

and the process ended with wrapping.

Customers were thrilled with the new and improved burgers. However, during busy

times, it wasn't feasible to make each burger as ordered. Lines formed, creating more

customer complaints. This time complaints were about the system.

As work moves through the processes and systems, check points will monitor changes

that need to take place - changes like removing barriers to quality by providing

employees with the tools needed to do the job right the first time.

Finally, managers take action. Management may make changes. Deming tweaked a

few things to speed up the process by placing more people on the line. Customers

received their burgers on time, and they were tasty, too!

Juran's Approach To Quality Planning, Control And ImprovementJoseph Juran shared a connection with Deming. Juran's approach to quality control also

had Japanese roots. While Japan was price-competitive with the rest of the world, the

quality of product did not measure up.

Like Deming, Juran stressed the importance of total quality management. However, he

summed it up by saying total quality management begins at the top of an organization

and works its way down. He developed 10 steps to quality improvement. The steps boil

down to three main areas of management decision-making:

Quality planning

Quality control

Quality improvement

Quality planning involves building an awareness of the need to improve, setting goals

and planning for ways goals can be reached. This begins with management's

commitment to planned change. It also requires a highly trained and qualified staff.

Juran managed Beefy's during the night shift. He set the standard for quality during his

shift by training each employee on how to properly make a burger.

Quality control means to develop ways to test products and services for quality. Any

deviation from the standard will require changes and improvements. On Sunday nights

when business was slow, Juran invited mystery diners to come to Beefy's to rate the

quality of the burgers. If he found that a diner was displeased, he retrained employees.

Quality improvement is a continuous pursuit toward perfection. Management

analyzes processes and systems and reports back with praise and recognition when

things are done right. Juran allowed the staff to engage in a well-deserved burger-

eating contest at the end of a profitable shift.

Crosby's Ideology Of Conformance To Quality StandardsPhilip B. Crosby was a contemporary leader in TQM. He didn't engineer principles or

steps. He simply made TQM easier for the layman to implement by breaking it down to

an understandable ideology that organizations should adopt.

Crosby re-defined quality to mean conformity to standards set by the industry or

organization that must align with customer needs.

There are Four Absolutes of Quality Management necessary for conformity:

Quality is defined as conformance to standards

The system for causing quality is prevention

The performance standard is not arbitrary; it must be without defect

The measurement of quality is price of non-conformance

Crosby worked the register at Beefy's. He was also a business student at the local

college. He used Beefy's as a field study on TQM. When customers sent back burgers,

he looked at the price of inferior products and its toll on the overall organization.Continue reading...

Taught by

Kat Kadian-Baumeyer

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Management Theories & Concepts at the Workplaceby Madison Hawthorne, Demand Media

Management theories are implemented to help increase organizational productivity and service quality. Not many managers use a singular theory or concept when implementing strategies in the workplace: They commonly use a combination of a number of theories, depending on the workplace, purpose and workforce. Contingency theory, chaos theory and systems theory are popular management theories. Theory X and Y, which addresses management strategies for workforce motivation, is also implemented to help increase worker productivity.

Contingency TheoryThis theory asserts that managers make decisions based on the situation at hand rather than a "one size fits all" method. A manager takes appropriate action based on aspects most important to the current situation. Managers in a university may want to utilize a leadership approach that includes participation from workers, while a leader in the army may want to use an autocratic approach.

Systems TheoryManagers who understand systems theory recognize how different systems affect a worker and how a worker affects the systems around them. A system is made up of a variety of parts that work together to achieve a goal. Systems theory is a broad perspective that allows managers to examine patterns and events in the workplace. This helps managers to coordinate programs to work as a collective whole for the overall goal or mission of the organization rather than for isolated departments.

Related Reading: What Are Effective Management and Motivational Theories in Relation to Problem Solving?

Chaos TheoryChange is constant. Although certain events and circumstances in an organization can be controlled, others can't. Chaos theory recognizes that change is inevitable and is rarely

controlled. While organizations grow, complexity and the possibility for susceptible events increase. Organizations increase energy to maintain the new level of complexity, and as organizations spend more energy, more structure is needed for stability. The system continues to evolve and change.

Theory X and Theory YThe management theory an individual chooses to utilize is strongly influenced by beliefs about worker attitudes. Managers who believe workers naturally lack ambition and need incentives to increase productivity lean toward the Theory X management style. Theory Y believes that workers are naturally driven and take responsibility. While managers who believe in Theory X values often use an authoritarian style of leadership, Theory Y leaders encourage participation from workers.

References (2)About the AuthorMadison Hawthorne holds a bachelor's degree in creative writing, a master's degree in social work and a master's degree in elementary education. She also holds a reading endorsement and two years experience working with ELD students. She has been a writer for more than five years, served as a magazine submission reviewer and secured funding for a federal grant for a nonprofit organization. Hawthorne also swam competitively for 10 years and taught for two years.

Photo Credits Creatas Images/Creatas/Getty Images

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http://www.kernsanalysis.com/sjsu/ise250/history.htm

This paper is an overview of four important areas of management theory: Frederick Taylor's Scientific Management, Elton Mayo's Hawthorne Works experiments and the human relations movement, Max Weber's idealized bureaucracy, and Henri Fayol's views on administration. It will provide a general description of each of these management theories together with observations on the environment in which these theories were applied and the successes that they achieved.

Frederick Taylor - Scientific Management

Description

Frederick Taylor, with his theories of Scientific Management, started the era of modern management. In the late nineteenth and early twentieth centuries, Frederick Taylor was decrying the " awkward, inefficient, or ill-directed movements of men" as a national loss. He advocated a change from the old system of personal management to a new system of scientific management. Under personal management, a captain of industry was expected to be personally brilliant. Taylor claimed that a group of ordinary men, following a scientific method would out perform the older "personally brilliant" captains of industry.

Taylor consistently sought to overthrow management "by rule of thumb" and replace it with actual timed observations leading to "the one best" practice. Following this philosophy he also advocated the systematic training of workers in "the one best practice" rather than allowing them personal discretion in their tasks. He believed that " a spirit of hearty cooperation" would develop between workers and management and that cooperation would ensure that the workers would follow the "one best practice." Under these philosophies Taylor further believed that the workload would be evenly shared between the workers and management with management performing the science and instruction and the workers performing the labor, each group doing "the work for which it was best suited."

Taylor's strongest positive legacy was the concept of breaking a complex task down in to a number of small subtasks, and optimizing the performance of the subtasks. This positive legacy leads to the stop-watch measured time trials which in turn lead to Taylor's strongest negative legacy. Many critics, both historical and contemporary have pointed out that Taylor's theories tend to "dehumanize" the workers. To modern readers, he stands convicted by his own words:

" … in almost all of the mechanic arts, the science which underlies each act of each workman is so great and amounts to so much that the workman who is best suited to actually doing the work is incapable of fully understanding this science, without the guidance and help of those who are working with him or over him, either through lack of education or through insufficient mental capacity."

And:

"to work according to scientific laws, the management must takeover and perform much of the work which is now left to the men; almost every act of the workman should be preceded by one or more preparatory acts of the management which enable him to do his work better and quicker than he otherwise could."

The Principles of Scientific Management

Environment

Taylor's work was strongly influenced by his social/historical period. His lifetime (1856-1915) was during the Industrial Revolution. The overall industrial environment of this period is well documented by the Dicken's classicHard Times or Sinclar's The Jungle. Autocratic management was the norm. The manufacturing community had the idea of interchangeable parts for almost a century. The sciences of physics and chemistry were bringing forth new miracles on a monthly basis.

One can see Taylor turning to "science" as a solution to the inefficiencies and injustices of the period. His idea of breaking a complex task into a sequence of simple subtasks closely mirrors the interchangeable parts ideas pioneered by Eli Whitney earlier in the century. Furthermore, the concepts of training the workers and developing "a hearty cooperation" represented a significant improvement over the feudal human relations of the time.

Successes

Scientific management met with significant success. Taylor's personal work included papers on the science of cutting metal, coal shovel design, worker incentive schemes and a piece rate system for shop management. Scientific management's organizational influences can be seen in the development of the fields of industrial engineering, personnel, and quality control.

From an economic standpoint, Taylorism was an extreme success. Application of his methods yielded significant improvements in productivity. Improvements such as Taylor's shovel work at Bethlehem Steel Works (reducing the workers needed to shovel from 500 to 140) were typical.

Human Relations Movement - Hawthorne Works Experiments

Description

If Taylor believed that science dictated that the highest productivity was found in "the one best way" and that way could be obtained by controlled experiment, Elton Mayo's experiences in the Hawthorne Works Experiments disproved those beliefs to the same extent that Michelson's experiments in 1926 disproved the existence of "ether." (And with results as startling as Rutherford's.)

The Hawthorne Studies started in the early 1920's as an attempt to determine the effects of lighting on worker productivity. When those experiments showed no clear correlation between light level and productivity the experiments then started

looking at other factors. Working with a group of women, the experimenters made a number of changes, rest breaks, no rest breaks, free meals, no free meals, more hours in the work-day / work-week, fewer hours in the work-day / work-week. Their productivity went up at each change. Finally the women were put back to their original hours and conditions, and they set a productivity record.

This strongly disproved Taylor's beliefs in three ways. First, the experimenters determined that the women had become a team and that the social dynamics of the team were a stronger force on productivity than doing things "the one best way." Second, the women would vary their work methods to avoid boredom without harming overall productivity. Finally the group was not strongly supervised by management, but instead had a great deal of freedom.

These results made it clear that the group dynamics and social makeup of an organization were an extremely important force either for or against higher productivity. This caused the call for greater participation for the workers, greater trust and openness in the working environment and a greater attention to teams and groups in the work place.

Environment

The human relations movement that stemmed from Mayo's Hawthorne Works Experiments was borne in a time of significant change. The Newtonian science that supported "the one best way" of doing things was being strongly challenged by the "new physics" results of Michalson, Rutherford and Einstein. Suddenly, even in the realm of "hard science" uncertainty and variation had found a place. In the work place there were strong pressures for shorter hours and employee stock ownership. As the effects of the 1929 stock market crash and following depression were felt, employee unions started to form.

Successes

While Taylor's impacts were the establishment of the industrial engineering, quality control and personnel departments, the human relations movement's greatest impact came in what the organization's leadership and personnel department were doing. The seemingly new concepts of "group dynamics", "teamwork" and organizational "social systems" all stem from Mayo's work in the mid-1920's.

Max Weber - Bureaucracy

Description

At roughly the same time, Max Weber was attempting to do for sociology what Taylor had done for industrial operations. Weber postulated that western

civilization was shifting from "wertrational" (or value oriented) thinking, affective action (action derived from emotions), and traditional action (action derived from past precedent to "zweckational" (or technocratic) thinking. He believed that civilization was changing to seek technically optimal results at the expense of emotional or humanistic content.

Viewing the growth of large-scale organizations of all types during the late nineteenth and early twentieth centuries, Weber developed a set of principles for an "ideal" bureaucracy. These principles included: fixed and official jurisdictional areas, a firmly ordered hierarchy of super and subordination, management based on written records, thorough and expert training, official activity taking priority over other activities and that management of a given organization follows stable, knowable rules. The bureaucracy was envisioned as a large machine for attaining its goals in the most efficient manner possible.

Weber did not advocate bureaucracy, indeed, his writings show a strong caution for its excesses:

"…the more fully realized, the more bureaucracy "depersonalizes" itself, i.e., the more completely it succeeds in achieving the exclusion of love, hatred, and every purely personal, especially irrational and incalculable, feeling from the execution of official tasks"

or:

"By it the performance of each individual worker is mathematically measured, each man becomes a little cog in the machine and aware of this, his one preoccupation is whether he can become a bigger cog."

Environment

Weber, as an economist and social historian, saw his environment transitioning from older emotion and tradition driven values to technological ones. It is unclear if he saw the tremendous growth in government, military and industrial size and complexity as a result of the efficiencies of bureaucracy, or their growth driving those organizations to bureaucracy.

Successes

While Weber was fundamentally an observer rather than a designer, it is clear that his predictions have come true. His principles of an ideal bureaucracy still ring true today and many of the evils of today's bureaucracies come from their deviating from those ideal principles. Unfortunately, Weber was also successful in predicting that bureaucracies would have extreme difficulties dealing with individual cases.

It would have been fascinating to see how Weber would have integrated Mayo's results into his theories. It is probable that he would have seen the "group dynamics" as "noise" in the system, limiting the bureaucracy's potential for both efficiency and inhumanity.

Henri Fayol - Administration

Description

With two exceptions, Henri Fayol’s theories of administration dovetail nicely into the bureaucratic superstructure described by Weber. Henri Fayol focuses on the personal duties of management at a much more granular level than Weber did. While Weber laid out principles for an ideal bureaucratic organization Fayol’s work is more directed at the management layer.

Fayol believed that management had five principle roles: to forecast and plan, to organize, to command, to co-ordinate and to control. Forecasting and planning was the act of anticipating the future and acting accordingly. Organization was the development of the institution's resources, both material and human. Commanding was keeping the institution’s actions and processes running. Co-ordination was the alignment and harmonization of the groups’ efforts. Finally, control meant that the above activities were performed in accordance with appropriate rules and procedures.

Fayol developed fourteen principles of administration to go along with management’s five primary roles. These principles are enumerated below:

 

Specialization/division of labor Authority with responsibility Discipline Unity of command Unity of direction Subordination of individual interest to the general interest Remuneration of staff

Centralization Scalar chain/line of authority Order Equity Stability of tenure Initiative Esprit de corps

 

The final two principles, initiative and esprit de corps, show a difference between Fayol’s concept of an ideal organization and Weber’s. Weber predicted a completely impersonal organization with little human level interaction between its members. Fayol clearly believed personal effort and team dynamics were part of a "ideal" organization.

Environment

Fayol was a successful mining engineer and senior executive prior to publishing his principles of "administrative science." It is not clear from the literature reviewed if Fayol’s work was precipitated or influenced by Taylor’s. From the timing, 1911 publication of Taylor’s "The Principles of Scientific Management" to Fayol’s work in 1916, it is possible. Fayol was not primarily a theorist, but rather a successful senior manager who sought to bring order to his personal experiences.

Successes

Fayol’s five principle roles of management are still actively practiced today. The author has found "Plan, Organize, Command, Co-ordinate and Control" written on one than one manager’s whiteboard during his career. The concept of giving appropriate authority with responsibility is also widely commented on (if not well practiced.) Unfortunately his principles of "unity of command" and "unity of direction" are consistently violated in "matrix management" the structure of choice for many of today’s companies.

Conclusion

It is clear that modern organizations are strongly influenced by the theories of Taylor, Mayo, Weber and Fayol. Their precepts have become such a strong part of modern management that it is difficult to believe that these concepts were original and new at some point in history. The modern idea that these concepts are "common sense" is strong tribute to these founders.

 

 

Reference:

Print:

75 Years of Management Ideas and Practice, David Sibbet, September/October 1997 Supplement, Harvard Business Review, Reprint number 97500

The Hunters and the Hunted, Swartz, James, 1994, Productivity Press, Portland OR

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Posted on May 2, 2014 by Tim Friesner

Marketing’s Relationship with other Functions

Functions within an organization

The marketing function within any organization does not exist in isolation.

Therefore it’s important to see how marketing connects with and permeates

other functions within the organization. In this next section let’s consider how

marketing interacts with research and development,

production/operations/logistics, human resources, IT and customer service.

Obviously all functions within your organization should point towards the

customer i.e. they are customer oriented from the warehouseman that packs

the order to the customer service team member who answers any queries

you might have. So let’s look at these other functions and their relationship

with marketing.

Research and development

Research and development is the engine within an organization which

generates new ideas, innovations and creative new products and services.

For example cell phone/mobile phone manufacturers are in an industry that is

ever changing and developing, and in order to survive manufacturers need to

continually research and develop new software and hardware to compete in a

very busy marketplace. Think about cell phones that were around three or

four years ago which are now completely obsolete. The research and

development process delivers new products and is continually innovating.

Innovative products and services usually result from a conscious and

purposeful search for innovation opportunities which are found only within a

few situations.

Peter Drucker (1999)

Research and development should be driven by the marketing concept. The

needs of consumers or potential consumers should be central to any new

research and development in order to deliver products that satisfy customer

needs (or service of course). The practical research and development is

undertaken in central research facilities belonging to companies, universities

and sometimes to countries. Marketers would liaise with researchers and

engineers in order to make sure that customer needs are represented.

Manufacturing processes themselves could also be researched and

developed based upon some aspects of the marketing mix. For example

logistics (place/distribution/channel) could be researched in order to deliver

products more efficiently and effectively to customers.

Production/operations/logistics

As with research and development, the operations, production and logistics

functions within business need to work in cooperation with the marketing

department.

Operations include many other activities such as warehousing, packaging and

distribution. To an extent, operations also includes production and

manufacturing, as well as logistics. Production is where goods and services

are generated and made. For example an aircraft is manufactured in a

factory which is in effect how it is produced i.e. production. Logistics is

concerned with getting the product from production or warehousing, to retail

or the consumer in the most effective and efficient way. Today logistics would

include warehousing, trains, planes and lorries as well as technology used for

real-time tracking.

Obviously marketers need to sell products and services that are currently in

stock or can be made within a reasonable time limit. An unworkable scenario

for a business is where marketers are attempting to increase sales of a

product whereby the product cannot be supplied. Perhaps there is a

warehouse full of other products that our marketing campaign is ignoring.

Human resources

Human Resource Management (HRM) is the function within your organization

which overlooks recruitment and selection, training, and the professional

development of employees. Other related functional responsibilities include

well-being, employee motivation, health and safety, performance

management, and of course the function holds knowledge regarding the legal

aspects of human resources.

So when you become a marketing manager you would use the HR

department to help you recruit a marketing assistant for example. They

would help you with scoping out the job, a person profile, a job description,

and advertising the job. HR would help you to score and assess application

forms, and will organise the interviews. They may offer to assist at interview

and will support you as you make your job offer. You may also use HR to

organise an induction for your new employee. Of course there is the other

side of the coin, where HR sometimes has to get tough with underperforming

employees. These are the operational roles of HR.

Your human resources Department also have a strategic role. Moving away

from traditional personnel management, human resources sees people as a

valuable asset to your organization. Say they will assist with a global

approach to managing people and help to develop a workplace culture and

environment which focuses on mission and values.

They also have an important communications role, and this is one aspect of

their function which is most closely related to marketing. For example the HR

department may run a staff development programme which needs a

newsletter or a presence on your intranet. This is part of your internal

marketing effort.

IT (websites, intranets and extranets)

If you’re reading this lesson right now you are already familiar with IT or

Information Technology. To define it you need to consider elements such as

computer software, information systems, computer hardware (such as the

screen you are looking at), and programming languages. For our part is

marketers we are concerned with how technology is used to treat information

i.e. how we get information, how we process it, how we store the information,

and then how we disseminate it again by voice, image or graphics. Obviously

this is a huge field but for our part we need to recognise the importance of

websites, intranets and extranets to the marketer. So here’s a quick intro.

A website is an electronic object which is placed onto the Internet. Often

websites are used by businesses for a number of reasons such as to provide

information to customers. So customers can interact with the product,

customers can buy a product, more importantly customers begin to build a

long-term relationship with the marketing company. Information Technology

underpins and supports the basis of Customer Relationship Management

(CRM), a term which is investigated in later lessons.

An intranet is an internal website. An intranet is an IT supported process

which supplies up-to-date information to employees of the business and other

key stakeholders. For example European train operators use an intranet to

give up-to-date information about trains to people on the ground supporting

customers.

An extranet is an internal website which is extended outside the organization,

but it is not a public website. An extranet takes one stage further and

provides information directly to customers/distributors/clients. Customers are

able to check availability of stock and could check purchase prices for a

particular product. For example a car supermarket could check availability of

cars from a wholesaler.

Customer service provision

Customer service provision is very much integrated into marketing. As with

earlier lessons on what is marketing?, the exchange process, customer

satisfaction and the marketing concept, customer service takes the needs of

the customer as the central driver. So our customer service function revolves

around a series of activities which are designed to facilitate the exchange

process by making sure that customers are satisfied.

Think about a time when you had a really good customer service experience.

Why were you so impressed or delighted with the customer service? You

might have experienced poor customer service. Why was it the case?

Today customer service provision can be located in a central office (in your

home country or overseas) or actually in the field where the product is

consumed. For example you may call a software manufacturer for some

advice and assistance. You may have a billing enquiry. You might even wish

to cancel a contract or make changes to it. The customer service provision

might be automated, it could be done solely online, or you might speak to a

real person especially if you have a complex or technical need. Customer

service is supported by IT to make the process of customer support more

efficient and effective, and to capture and process data on particular

activities. So the marketer needs to make sure that he or she is working with

the customer service provision since it is a vital customer interface. The

customer service provision may also provide speedy and timely information

about new or developing customer needs. For example if you have a

promotion which has just been launched you can use the customer service

functions to help you check for early signs of success.

Posted in Marketing Principles

 

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Consumer Behaviour  (13)

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