Juran Blog

This week marks the beginning of the school year for many K – 12 students, as well as for those returning to their collegiate schedules. As the school system approaches a new year of learning, the teachers awaiting the arrival of fresh faces in their classrooms begin to question the impact they will have on these students—some eager to learn and some more or less disillusioned about the importance of their education. If teachers expect quality behavior and quality results in their classroom, there are three important steps to remember:

1. Maintain quality leadership
2. Embrace creativity and risks
3. Meet basic needs

These three steps are key to any improvement initiative in any organization; they are the method to achieve superior quality and sustainable results. Maintaining quality leadership simply means the existence of an executive management team who supports, embraces, and sustains the norms and behaviors expected of all working in the organization, whether it be the principal or the floor manager, students or assembly line workers. Embracing risks and creativity is the first step to resolving quality problems in any organization. All members of the organization must brainstorm together, believing that a resolution can be found in the creativity and risk-taking of those who work closest with the process, product, or service in question. Playing off one another’s ideas and taking a methodical approach to explore and test them is the beginning of a truly motivated and high-functioning team. Last but not least, remember to meet basic needs. Your internal and external customers, in this case of school system quality—students, have needs that must be fulfilled and satisfied in order for quality implementation to be seen as successful. Not meeting the smallest need can mean a dissatisfied customer and result in a failed quality improvement initiative, such as a student disillusioned about the importance of their education.

Jaclyn Allard
Client Relationship Associate

For four months now, I have been following and participating in a group discussion on LinkedIn.com. At the beginning of 2010, The Healthcare Information Management Systems Society (HIMSS) group posted the aforementioned topic, promoting discussion. Since its inception, the posting has accumulated almost 400 comments from clinicians, healthcare executives, HIT professionals, and EMR vendors. I want to take this opportunity to summarize the most highly discussed reasons for EMR/EHR implementation failure. By placing the key topics of discussion into affinity groups, we can better recognize the vital few variables contributing to these common failures.

Stakeholder and Process Requirements ranked #1 in the discussion, comprising over 25% of the total responses. The fact that this is the most significant topic of discussion is an indication that this has been a common stumbling point for organizations facing EMR implementation. For EMR implementations to be successful, organizations must consider all of the stakeholders of the EMR. First and foremost, the patient, patient safety, and compliance standards are considered. Additional key stakeholders include physicians, other clinical staff, front line staff, and IT.

Change Management ranked #2, comprising almost 23% of the total responses. Included under this topic were many comments regarding lack of physician and clinician buy-in, lack of training and support, in addition to the actual scheduling and process of implementation. From the volume of discussion revolving around this topic, it is clear that cultivating physician support is essential to the success of the project. Ensuring that proper training occurs before implementation and the availability of continued support occurs after implementation are just as important.

Vendor Failures ranked #3, comprising almost 13% of the total responses. More specific details contributing to this topic are the failure of EMR vendors to follow through with their deliverables, their inability to provide customized solutions and features, and their failure to facilitate a successful “hand-off” to their customers. In a growing and competitive market, prospective customers must be careful in their decision to choose a provider, ensuring that they are capable and can be held to the expectations set at the point-of-sale.

Failures in Existing Processes ranked #4 in the discussion. It seems self-explanatory that a tool, no matter how sophisticated, is bound to fail if it is built upon poor processes. Addressing the current issues within processes would be ideal before investing in such an expensive and complimentary tool.

Are these topics of discussion consistent with your EMR experiences?  What are your top 3 reasons for EMR failure?

Ryan Walker
Consultant, Juran Healthcare

In recent years, popularization and diversity of social networks have skyrocketed. Social networking sites, such as Facebook, LinkedIn, MySpace, and Twitter, continue to experience an astonishing growth. However, business growth does not necessarily equate to increased service quality. The question that immediately comes to mind is: What is social network quality and how do you measure it?

Dr. Joseph Juran defines quality as “fitness for use.” In the context of social network services, this will imply effectiveness of design, infrastructure, and support methods employed in delivering a social network that fits a customer’s defined purpose. Social network quality can be viewed in several dimensions.  Some of the most important ones are summarized below:

Conformance to Specifications – indicates a social network free of failures and defects (e.g. server downtime, code errors and etc.)

Features and Content – implies functionality and information that satisfies customer expectations

Safety and Security – requires mechanisms in place to protect social network users from theft, injury, and danger (e.g. child protection, hacker protection and etc.)

Privacy – entails storage, distribution, and usage of personal information with the users’ knowledge and consent (customers value privacy and the lack of it creates dissatisfaction)

Access – suggests 24/7 access to the social networks from computers and mobile devices

How do you define social network quality in your company? Which dimensions of quality do you consider most important? Are there any other dimensions of social network quality?

Angel Tonchev
Senior Consultant

Christo Tonchev
Senior Consultant

One of the biggest challenges facing our U.S. military today, like many organizations, is leadership. 

According to the Washington Post, since 2001, a dozen commanders have cycled through top jobs in Iraq, Afghanistan, and the U.S. Central Command which oversees both wars. 

To put this in perspective, imagine your organization turning over key C-suite leaders a dozen times in nearly a decade?  What impact would that have on your culture, your customers, and your company’s health?

The U.S. military is struggling with the same issues we see in many organizations. More and more Boards and CEOs are asking the vital question:  “How can we build and sustain the leadership pipeline and ensure a succession of capable leaders who can manage and lead change?”

It has never been more important for the military, and every organization for that matter, to be focused on building capable leaders for the future.  It’s understandable that fighting the battle or managing through a recession is a priority right now.  Nonetheless, without a plan to develop and sustain leaders, those business objectives cannot be achieved. 

There are four key questions to ask when assessing your leadership bench (military, services, manufacturing, etc. leaders alike):

1. What leadership skills and perspectives are critical for success now and in the future?
2. How strong are current leaders in these critical skills and perspectives?
3. How aligned is today’s leadership strength with what will be the most important skills and perspectives in the future?
4. What are the critical positions or roles that are vital to the organization’s success? 

After all, there’s no substitute for strong leadership.

Janice Doucet Thompson, MHROD

Design for Six Sigma (DFSS) is beneficial in the healthcare arena now more than ever. On February 17th, 2009 the American Recovery and Reinvestment Act of 2009 (ARRA) was signed by President Obama. This act, also known as the Stimulus or the Recovery Act, provides incentives to hospitals able to implement an Electronic Medical Record (EMR) and prove meaningful use by 2015. Inability to do so by the 2015 deadline will result in a Medicare reimbursement penalty, which increases through 2017 at which point it becomes permanent.

Hospitals and Hospital systems are quickly evaluating their current financial status and frantically deciding how they will meet the requests of the ARRA. Implementing an EMR is not a simple or cheap task; it requires time, money, training, and adjusting to a new culture and way of operating. Hospitals need to weigh the benefits of rapidly implementing an EMR to receive the monetary incentives versus taking the time to properly plan, train, and install a more fully functional system at the expense of penalties and lost incentives. Costs for rework, software fixes, and updates to bring a rushed implementation up to optimal effectiveness and efficiency, or even certification, can easily exceed the incentive amount received for meeting the deadlines.

A major downfall for a rushed implementation is the failure to properly assess the current processes. Poorly performing processes should not be masked with an electronic system; this ultimately makes future process improvement projects not only more challenging, but more costly when redevelopment upgrades of the software are required.

The recommended approach is to take the time to evaluate the current state using a methodology such as Design for Six Sigma – DMADV (Define, Measure, Analyze, Design, Verify). It is essential to redesign the current processes with an electronic system in mind to determine the needs of the Hospital and its customers. This way, upon EMR implementation, the software can be designed from the start to address these needs and the newly designed features of the process. This approach will provide a smoother transition into the age of the Electronic Medical Record by having a significant impact on, as mentioned in the June 16th post by Steve Doerman, “consumer satisfaction, the company’s profitability, and even on the morale of the workforce.”

Geeno Carlone
Consultant, Juran Healthcare

This past weekend was the annual celebration of Father’s Day, a day of reclined relaxation, homemade cards, and store-bought trinkets for dear old dad. Behind the commercial rise of this holiday, remains the tender appreciation for fathers worldwide. From these many patriarchs, we learn about right from wrong, hardwork, tradition, and lessons learned. Therefore, it is without question that Juran would give thanks to its Founding Father, and that the world of quality and performance excellence would pay tribute to its roots—Dr. Joseph M. Juran.

Dr. Juran was a man with many children (stakeholders, specialists, customers, etc.), whom he continues to teach, through his published works, about the universal methods to manage for quality—principles that are valid no matter what the product, process, or function. It was his belief that adaptation from poor quality to superior quality and sustainable results was possible for all industries, products, and processes. A commonality can be found in the universals of quality; there is a “common principle to which both the specific situation and the derived knowledge correspond” (Juran Quality Handbook Sixth Edition xxi).

The pursuit of high quality can transform a culture, and freedom from failure leaves all customers—internal and external—satisfied. Consumers have expectations that rise faster than typical market improvement. Transforming culture can only be possible through the acceptance of your consumers’ perceptions, wants, and needs. Satisfaction is forever fleeting, and therefore, quality is forever evolving. Dr. Juran—the Father of Quality—will not be forgotten, for his published works and lessons learned continue to create value for society through superior quality and sustainable results.

Jaclyn Allard
Client Relationship Associate

One of the many benefits of working in the consulting business is the opportunity to be involved in many different processes. Focusing my consulting services mainly in the manufacturing industry, I have enjoyed learning how different products are made, from one unit taking a month and a half to complete to processes that produce over six million units a shift. One thing I often see, regardless of industry, is the significant impact of the product design (and related process design) on consumer satisfaction, the company’s profitability, and even on the morale of the workforce.

My associate, Michael Moscynski, touched on the problem in his June 7th post, commenting on the struggles of many companies to maintain acceptable quality. His focus was on opportunities that can be gained by statistical tools such as Design for Six Sigma, an excellent approach to reduce inherent variation before it becomes embedded into the fabric of the process. A great way to go, but benefit can also be derived from a proactive approach to reduce waste as part of the product/process design. As I mentioned earlier, I see a lot of waste reduction efforts after the fact. If equal efforts were made initially at the design step, production costs would be lower and customer satisfaction would improve from the first product produced. This is particularly true in the early stage of the product’s life cycle, where customers can demonstrate long-term loyalty if high quality and reliable delivery are in place from the offset.

When considering “waste elimination,” most process improvement practitioners think of the Lean principles rooted in Toyota. Despite the quality issues that Toyota has recently experienced, it is hard to argue the benefit of the Toyota Production System and its impact on reducing process and production wastes. When reviewing how effective Toyota is at incorporating their methods into the product and process Design Phase, the results are obvious—rarely do they miss a design milestone and seldom are there manufacturing issues after prototyping—unlike the experience of many of their competitors. Carefully integrating Lean early into the Design Phase will yield a long-term payback.

My comments here are not to go into great depth of the mechanics of the Toyota Production System, the techniques of Lean, or the detailed process of Production Development; I will leave that for the reader to explore. My point here is the importance of listening to the Voice of the Customer, while minimizing the wastes that can creep into processes and financial statements. One Toyota principle is worth noting: nemawashi—make decisions slowly by consensus, thoroughly considering all options; implementing rapidly.  With this as a foundation, there are many tools available such as Lean’s Standardized Operations, Value Stream Mapping, and the statistical approach such as DFSS, to name but a few. If successfully executed, the results will be product and process designs robust enough to meet the needs of the customer and increase profitability.

Steve Doerman
Client Relationship Executive

Recently, it seems more companies are singing the “Can’t Get No Quality” blues.

The recent list is long:

• Johnson & Johnson’s children’s Tylenol recall
• Ikea’s mattress recall
• Boeing’s troubles and delays bringing out the new 787 Dreamliner
• Toyota’s accelerator pedal problems
• The BP oil spill
• Ground beef, spinach, etc.—food recalls
• Maytag recalls for fire hazard
• McDonald’s recall of theme glasses because of a possible cadmium risk

You get the idea. The list goes on and on.

How can such brand name companies be crossing the foul line so frequently?

In truth, there is more coverage of everything. The media is searching 24/7 for stories, and the “reporters” have increased—they are us. Many of us have mobile phones with cameras, and audio and video capability. The videos can be downloaded and sent to our friends. The pictures can be instant and compelling. It is not just through cable media that the stories spread, but also through Twitter, blogs, and the Internet. We don’t just have Big Brother; we have millions of little brothers and sisters. They are all watching and they all have cell phones!

The supply of stories is rising as well, and not just from increased reporting.  In a global economy, new products must be turned out more quickly. With global competition, more companies are outsourcing more components or even the design. The pressure for speed and cost are high. Quality can get left behind.

It is clear we have more reporters, more products, and more outsourcing in the supply chain. The supply of reporters is not going down anytime soon. So the answer is in better product designs and better use of vendor suppliers.

Perhaps it is time to get back to some fundamentals. The use of Design for Six Sigma (DFSS)- DMADV is a great tool for fast design cycles. Remember the old saying: Go slow to go fast. Speed that ends in recalls and embarrassment is a mistake. Cutting corners on costs can be devastating. The voice of the customer (VOC) is never to deliver fast and cheap at the price of meeting CTQs. Part of the process is to ensure reliability and robustness of design.

DFSS can help with vendors too. Too often when we decide to outsource a part or service, we want to forget about it. If it is your name on the product, you can never do that. Customers will not blame your vendor. They will blame you. 

Part of DFSS is to VERIFY. Verify that the end product will not only meet the cost delivery objectives, but also meet the reliability requirements and the customer’s CTQs. Work with your vendors to verify the design and the process.

The only thing harder than building a good reputation is rebuilding it after you have lost it!

Michael J. Moscynski
MBB

A major environmental catastrophe threatens the Gulf’s delicate eco-system, as well as the livelihood of thousands of Gulf fishermen and their families.

As the entire world watches this environmental disaster unfolding in the Gulf of Mexico, we ponder what sort of Quality Control processes BP had in place at the time of the technological mishap. Accidents happen, but we need to have a plan B in place when things go wrong, along with a robust Quality Control process.

Over forty years ago, Dr. Juran stated his concerns about the effect of poor quality, created by technology, on the environment. Dr. Juran coined the phrase: life behind the quality dikes. These quality dikes, as explained by Dr. Juran, are a way of securing benefits, such as the large oil rig platforms floating on our oceans providing us with the benefit of oil. Dr. Juran also warned that on occasion the quality dikes may spring a leak, and we must repair them before they get out of control.

BP’s leak has lead to an estimated flow of oil into the Gulf of Mexico somewhere between 12 to 19 thousand barrels of oil per day, destroying the Gulf’s precious marine and wildlife. If more careful planning and prevention were taken into consideration and a real Quality Control process was in place, this outcome could have been prevented. Obviously, drilling at 5,000 feet below the ocean will create challenges if something goes terribly wrong. Hopefully, BP took those risks into consideration before undertaking the deep sea oil-drilling process.

BP isn’t the only company and won’t be the last that will experience this kind of environmental catastrophe; Exxon and Union Carbide, to name just two, have had major environmental disasters, some with devastating effects on their business. Hopefully, this is a wakeup call for all industries and corporations to fully incorporate quality with an eye toward environmental sustainability across their enterprise. Companies that want to succeed and thrive in the future must find ways to meet their own strategic goals and needs, as well as those of society and the environment.

J.R. DeFeo
V.P. EcoQuality Systems

For an organization beginning their quality improvement journey, finding and traversing the road of optimal effectiveness and efficiency seems daunting. Where does one start? Juran’s Healthcare team is currently working with a retirement community trying to gain a better understanding of their current performance, realizing that meeting regulatory requirements does not result in the overall improvement they have the potential to achieve.

To begin, an organization should establish a solid foundation of performance metrics and analyze the data management processes. The afore mentioned retirement community is reevaluating their current list of metrics and how often the information is being reported. The members involved in the project have identified not only additional metrics to track, but also measures that more directly impact and influence regulatory requirements.

To facilitate monitoring and reporting, a Scorecard has been created to house and trend process and outcome measures monthly. Depending on the organization and the electronic tools available, some may wish to monitor results weekly or quarterly. It is crucial to regularly monitor the high level processes to better understand current process performance. If a process begins to perform unfavorably based on either an upward or a downward trend, immediate action to improve the poorly trending results should be initiated. It is helpful to drill down deeper into the performance data.

In order to provide a seamless transition from Scorecard observation to analysis of individual records, reevaluate how raw data is captured and recorded. Where the Scorecard provides a high level snap shot of the process, analysis of the raw data offers assessments of any point in time, isolating a possible special cause event. There are electronic solutions available to aid in automating the steps from collection to analysis to report. For those who wish to run statistical analysis software such as Minitab, formatting the data in a manner which can easily be read by these analysis packages is essential. Collecting and formatting the data appropriately from the start eliminates waste and rework.

Overall, observation of a process through an organized method of collecting and analyzing data is critical in establishing a foundation for continued process improvement. Capturing and reviewing data on a weekly or monthly basis not only meets scheduled regulatory deadlines, but offers greater oversight of current processes and insight into performance opportunities. Continual monitoring enables immediate response to negatively trending measures, establishing greater control and stability of an organization’s performance. Inefficiencies and poorly performing processes will begin to emerge through Scorecard trending, paving the road ahead for a quicker and clearer voyage down the road of optimal effectiveness and efficiency.

Geeno Carlone
Consultant, Juran Healthcare