The 5 most used

Quality
Management
tools in
healthcare DR. RESTY L. PICARDO
 Checklists
What are the
Pareto Charts
most used
quality Cause and effect diagram
(Ishikawa diagram)
management
tools in Scatter diagram

healthcare? Process flows

 CHECKLIST
A checklist is a sequence of tasks
or things presented in a way that
makes it easy for the user to
accomplish something.

Checklists are one of the

essential tools used not only in
healthcare but in almost any
aspect of our lives in which we
want to be organized.

Checklists can be sequenced or

not, and there are many uses for
them.
ONBOARDING CHECKLIS
Here are the tasks you should

T
complete during your first two
weeks on the job.

Submit requirements

Complete assessments

Attend onboarding

Meet with coach

Set up tools
How to use a checklist
in healthcare?
The first step is to define what is the use of the checklist
for clearly.
If there is a need for a sequenced checklist (task A
happens before B, B before C, etc.), the first step is to map
out all the steps required and the order they need to
happen.
The mapping exercise will provide the foundation for the
checklist. If this is the first time looking at giving structure
to a step, it’s essential to involve all stakeholders to ensure
no steps are missing.
If it’s not a sequenced list, the task becomes more
Goals & Tasks
manageable as all we need to do is ensure we record
everything that needs to happen.
 Why are checklists essential
as quality management tools
in healthcare?
Checklists are inexpensive compared to
potential quality issues that could damage
reputation and prevent from getting future
clients.

Checklists are an ally if one wants to ensure

a task gets done right the first time.

Standardization is what makes checklists so

powerful. They ensure quality and reduce
downtimes and allow you to put your effort into
what matters most, reducing decision fatigue.

Last but not least, checklist could be used as a benchmark in

continuous improvement cycle. If the team sees gaps in its
structure after a few days or months of using the same checklist,
one can update it to save even more time or prevent any
unforeseen quality issues.
 Pareto
charts
A Pareto chart is a double chart that contains:

• An ordered bar chart (number of times a specific event

occurs plotted as a bar) in descendant order.
• A line represents the cumulative total of the different
elements in the bar chart.
 PARETO CHARTS
Pareto charts take their name from Vilfredo
Pareto, an Italian economist, and civil
engineer. He made outstanding contributions
to studying income disparities among classes
and the analysis of people’s choices.
COLLABORATION
The Pareto principle takes its name
from him, stating that 80% of the
INTEGRITY consequences come from 20% of the
causes.
 If one follows what was said, 80% of
the issues come from 20% of the
causes.

That means we can eliminate 80% of

the problems if the focus is on the top
20% of causes. We can determine the
20% by following the cumulative
percentage shown in the bar.

As you can see, the frequency of the

“Poisoning” bar represents slightly
more than 20% of the admittances in
the hospital.

Based on this information, we can

create some guidance on how to
prevent food poisoning at home or
things to check in a restaurant to
 How to use a pareto
chart in healthcare?
Imagine one asks the customer service team to log
every time a customer makes a complaint.

Investigate those complaints and give them a root

cause, so now there is a table of complaints and
root causes.

The root causes can contribute tremendously to the

continuous improvement cycle.
Goals & Tasks
 Why are pareto charts
essential as quality
management tools in
healthcare?
Pareto charts are not only important in
healthcare. They are standard practice in
almost every industry.

From a cost point of view, they are one of

the most cost-effective ways of prioritizing
efforts to improve delivery and minimize the
time doctors spend with preventable
incidences.

As mentioned before, if focusing on only 20% of

your causes, you can get rid of 80% of the
issues. It looks like a no-brainer in terms of
impact and efficiency.
Cause and effect
diagrams
Is one of the main tools in any engineer’s toolbox. Kaoru Ishikawa, a
professor in engineering from the University of Tokyo, created them.

A cause and effect diagram helps one determine the cause of an

event by evaluating different elements of the product or service. It
simplifies evaluating risks and standardizes the process.
How to use a cause and effect
diagram in healthcare?
Put the event as the “head” of the fish. Then have
the different branches. There are six standard
branches in manufacturing.

Measure: How do we quantify the event?

Man: What interactions does the human have with
the event?
Method: Is there anything wrong with the process?
Environment: Are there any external conditions
influencing the event?
Material: Are the materials contributing to the
Goals & Tasks
event?
Machine: Are the tools contributing to the event?
How to use a cause and effect
diagram in healthcare?

We are not limited to 1 contributor per category. In

most cases, one might
Goalssee
& that
Tasksyou only need 2 or
3 types to determine the root cause of an issue.
 Why are cause and effect
diagrams essential as quality
management tools in
healthcare?
When evaluating an issue or a potential event, it’s
crucial to have a consistent approach to resolving
it.
Systematization is one of the most powerful things
one can introduce to ensure quality.

Having a systematic approach to evaluating causes

and effects will give one more and better insights
into what might go wrong.
The best bit about it is that one can involve the
Goals & Tasks
team and run a brainstorming session on
whichever topics worry one to maximize the
 Scatter
Diagrams
A scatter diagram is a chart that allows one to understand the
relationship between 2 variables.

These two variables can be whatever one imagine. For example, on

one axis, we can plot the height of patients and, on the other, their
weight. It can give an indication of whether the two variables are
How to use a scatter
diagrams?
Ideally, one wants to use something like
Microsoft Excel to help one out with this
task.

Or one can code something in Python

with Plotly to make it look fancy. Either
way, one need to use something that
allows one to plot the values.

Goals & Tasks

 Why are scatter diagrams
essential as quality
management tools in
healthcare?
Scatter plots can help one understand if
there is a correlation between the variables
being studied.

If the variables are correlated, one can go deeper

in the study to understand if one causes the
other or vice-versa.

But correlation doesn’t always mean causation,

and that’s super important to understand.

Scatter plots could help one understand the data

in a way one has not thought of previously.
 Flowcharts

Flowcharts describe all the steps required to achieve a goal or

complete a task.
Unlike checklists, when used correctly, define all the small steps to
complete a task very accurately. Process flows are top-level views
that allow you to achieve a goal.
 How to use a
flowcharts chart in
healthcare?
If you already have a process in place, it’s a matter
of documenting and investigating if any gaps need
covering.
The first step is to understand the end goal.

After that, there is a need to lay the different blocks

that will allow to get to the end goal.

Make sure the team contributes to this exercise,

especially those in charge of executing the different
blocks of work.
Make sure they understand why it is vital to
Goalsif&
use flowcharts Tasks
they want to ensure
quality.
 Why are flowcharts essential
as quality management tools
in healthcare?
Flowcharts allows one to represent what’s
required to achieve a specific goal.

They prevent issues from happening. They

also allow to step back and see if there are
any gaps in the processes.

They are tremendously helpful training tools. If

one has a new person joining the team, process
flows and checklists could reduce the time one
needs to train that person.

When combining different flowcharts, you could

end up with a QMS, which is a great way to
ensure quality.
 KEY TAKE AWAY
We must standardize our actions and tasks and
use data to make conscious decisions and
improvements to ensure quality.
To standardize our actions and tasks, we
can:
• Use checklists to ensure we don’t forget any steps to achieve our goal.

• Use cause and effect diagrams to understand the root of our issues and
• resolve them.
Use flowcharts to detach ourselves from the small details and have a clear
overview of the whole operation.

To make conscious improvements through data, we

•can:
Use scatter diagrams, to understand the relationship between different variables.
• Use Pareto charts to maximize the impact of our continuous improvement efforts.
PDSA CYCLE
 PDSA Cycle
The PDSA Cycle (Plan-Do-Study-Act) is a
systematic process for gaining valuable
learning and knowledge for the continual
improvement of a product, process, or
service. Also known as the Deming
Wheel, or Deming Cycle, this integrated
learning - improvement model was first
introduced to Dr. Deming by his mentor,
Walter Shewhart of the famous Bell
Goals & Tasks
Laboratories in New York.
 PLA
N
This involves identifying a goal or purpose,
formulating a theory, defining success metrics and
putting a plan into action.

A. Recruit the Team

B. Draft an aim statement
C. Describe current context and process
D. Describe the problem
INTEGRITY
E. Identify causes and alternatives
 RECRUIT THE TEAM
Assemble a team that has knowledge of the problem or opportunity for
improvement. Consider the strengths each team member brings—look for
engaged, forward-thinking staff.

After recruiting team members, identify roles and responsibilities, set

timelines, and establish a meeting schedule.

DRAFT AN AIM
STATEMENT
Describe what you want to accomplish in an aim statement.

Try to answer those three fundamental questions:

INTEGRITY • What are we trying to accomplish?

• How will we know that a change is an improvement?
• What change can we make that will result in improvement?
 DESCRIBE CURRENT
CONTEXT AND PROCESS
Brainstorm
Examine the current process. Start by asking the team these basic questions:
What are we doing now? How do we do it? What are the major steps in the process?
Who is involved? What do they do? What is done well? What could be done better?

One might have already answered the last two questions if you have performed a
SWOT analysis.
Try a swim lane
map
You may find it helpful to construct a swim lane map to visually describe a process.
Creating a process flow or at least depicting the current process can be very useful. If
the team runs into road blocks, one might have found where the problem is occurring
—or maybe the right person for identifying a missing step is not at the table.

INTEGRITY
Gather more detail
Once the general structure is completed, these can be some more helpful questions
to ask:
• How long does the process currently take? Each step?
 DESCRIBE THE PROBLEM
Using the aim statement created in Step B, state the
desired accomplishments, and use data and information to
measure how the organization meets/does not meet those
accomplishments.

For example: If the objective is to maximize your staff's quality of

work life, you might find evidence by surveying employees on
workplace stressors.

Write a problem statement

Write a problem statement to clearly summarize the team's consensus
on the problem. One may find it helpful to prioritize problems, if the
INTEGRITY
team has identified more than one, and/or include a justification of
why problem(s) were chosen.
 IDENTIFY CAUSES AND
ALTERNATIVES
Analyze causes
For the problem in the problem statement, work to identify causes of the
problem using tools such as control charts, fishbones, and work flow process
maps (e.g., flowcharts, swim lane maps). The end of the cause analysis
should summarize the cause analysis by describing and justifying the root
causes.
Develop alternatives
Try to mitigate root causes by completing the statement,

"If we do __________, then __________ will happen."

Choose an alternative (or a few alternatives) that one believes will best help
INTEGRITY reach the objective and maximize resources.

Develop an action plan, including necessary staff/resources and a timeline. Try to

account for risks one might face as action plan is implemented.
 DO
The components of the plan are
implemented
Start to implement the action plan. Be sure to collect
data as one goes, to help evaluate the plan in Stage 3:
Study. The team might find it helpful to use a check
COLLABORATION
sheet, flowchart, swim lane map, or run chart to capture
data/occurrences as they happen or over time.

INTEGRITY
The team should also document problems, unexpected
effects, and general observations.
 STUD
Y
Outcomes are monitored to test the validity of
the plan for signs of progress and success, or
problems and areas for improvement.
Using the aim statement drafted in Stage 1: Plan, and data gathered during
Stage 2: Do, determine:

•
•
COLLABORATION
Did the plan result in an improvement? By how much/little?
Was the action worth the investment?
• Was there a trend?
• Were there unintended side effects?
INTEGRITY
One can use a number of different tools to visually review and
evaluate an improvement, like a Pareto chart, control chart, or run
chart.
 ACT
Integrating the learning generated by the entire process,
which can be used to adjust the goal, change methods,
reformulate a theory altogether, or broaden the learning
– improvement cycle from a small-scale experiment to a
larger implementation Plan.

SUCCESS standardize the improvement and begin to

use it regularly.

Need a different approach to be Return to Stage 1: Plan, and

more successfuI? develop a new and different plan
 These four steps can be
repeated over and over
as part of a never-ending
cycle of continual
learning and
improvement.
THANK
S