美国华人麻醉医学会(Chinese American Society of Anesthesiology CASA) Newsletter, 2014(06)

Quality Assurance and Continuous Quality Improvement In Current Anesthesia Practice (Part 1)

Xiaoyan Zhang, MD Chair, patient safety and quality committee, CASA; Senior partner, South Bay Anesthesiology Group, PLCMMC., Torrance, California, USA

What is quality? What is quality assurance? (QA) What is continuous quality improvement (CQI)? How can we apply these concepts to update anesthesia QA and CQI in the current patient-centered and value-based payment system?

In this first part of QA and CQI, I will introduce some very basic concepts of Dr. W. Edwards Deming, the person who created the concept of "quality control (QC)" and best known for his Miracle with Statistic Product Quality Administration.

1. Definition The concept of Quality was introduced in the 1950s by Dr. Edwards Deming (Oct. 1900 - Dec. 1993), an American statistician, professor and consultant. According to Deming, Quality = (Results of work effort) / (Total costs). Quality is a statistic concept that involves consistency, accuracy (less errors and variations) and reliability. Quality results from long-term and continuous process of improvement. High quality is different from luxury. For example, Toyota car has better quality than Cadillac. It is because Toyota cars have consistently run smoother, lasted Xiaoyan Zhang‐Quality Assurance and Continuous Quality Improvement In Current Anesthesia Practice (Part 1)                    page  1 



美国华人麻醉医学会(Chinese American Society of Anesthesiology CASA) Newsletter, 2014(06)

longer and required less repair. Customers have experienced fewer problems for years. The main reason of Toyota’s high quality is that Toyota parts are made with less variations [smaller standard deviations (SD)]. And, for more than 50 years, Toyota cars are identified with high reliability [smaller standard errors (SE)]. Its high quality has manifested as low costs, verses high value, as well. Quality Assurance (QA) means to monitor the errors or mistakes in the system, namely to “watch out” for quality issues. Continuous Quality Improvement (CQI) means, according to Deming "Good enough isn't!”. In other words, merely “good enough” is NOT good enough. If you just prevent mistakes by QA, you make no progress. CQI would therefore emphasize quality improvement based on the problems identified by QA. Over time, the high quality will decrease the cost. As Deming further said, “if you rely on product inspection rather than product improvement, you will fall behind”.

2. History Dr. Edwards Deming, an American statistician, initially used his quality theory in Japanese industry to improve productivity and value in the 1950s. He is best known for his work to help Japan recover after WWII. He was the first to bring up the "Statistical Product Quality Administration", which is highly credited as the inspiration behind the “Japanese Miracle” of 1950-1960, which raised Japan from the ashes of war to the second most powerful economy in the world in less than a decade. Since then, the idea of quality management has been well accepted worldwide and applied to other fields, such as, business, education and the military. In the late of 1980s, the American healthy care was relatively late to join this quality movement. Until now, Deming's Quality Consulting Practice is still active around the world. Deming’s most famous “Deming's Cycle” is "PDCA" (Plan-Do-Check-Act), a repetitive process to determine the next action and to improve quality at the next higher level.

3. It's a system Quality improvement needs a system, as a network in which the interdependent components will work together to accomplish the common aim of the system.

4. A quality system requires transformation. Xiaoyan Zhang‐Quality Assurance and Continuous Quality Improvement In Current Anesthesia Practice (Part 1)                    page  2 



美国华人麻醉医学会(Chinese American Society of Anesthesiology CASA) Newsletter, 2014(06)

When the myriad of changes happens in a system, transformation into a new style of management will be required. It's unavoidable.

5. "There is no substitute for knowledge" in quality improvement. Quality improvement needs knowledge, and continuous education. It's not replaceable by information alone. The knowledge can save many hours of hard work, and teach how to do things right.

6. Quality should be reportable and measurable. "In God we trust; all others must bring data", emphasized Deming. Measurable and reportable data are the key of any system’s quality improvement. With these data or numbers, the system can do comparison, analysis and evaluation, and then carry out PDCA Cycles for consistent improvement.

7. Appreciation and Participation Everyone in the organization should understand the aim of the QA system, and appreciate the overall processes. A manager should encourage their workers to participate in QA management for consistent improvement. If any thing goes wrong, check the system for problems first, and avoid individual blaming as much as possible. Drive out the fear, so that every one will work efficiently and loyally for the company. Break down the barriers, so that the workers will report errors and mistakes to help improve the quality. Finally, create an environment of "joy in work", and at work. Encourage staff for suggestive, constructive and positive feedbacks.

References 1. Wikipedia, the free encyclopedia. Deming, W. Edwards. 2. Deming, W. Edwards. The New Economics for Industry, Government, and Education. (1993) Boston, MA ISBN 0262541165. 3. Aguyo, Rafael. Dr. Deming: The American Who Taught the Japanese About Quality. (1991) OCLC 229201675. 4. Deming, W. Edwards. Out of the Crisis. Cambridge, Mass. MIT Press. (2000) ISBN 0262541157. Xiaoyan Zhang‐Quality Assurance and Continuous Quality Improvement In Current Anesthesia Practice (Part 1)                    page  3