Authored by Joseph A. De Feo  

Is there a difference from a quality perspective between food production and goods manufacturing? You bet there is.

Food production processes materials by converting raw goods such as wheat into other products, including flour, bread, and cookies. Goods manufacturing assembles materials into products like electronics, appliances, or automobiles. This fundamental difference poses unique challenges for quality professionals in the food production industry.

Why food quality should be managed differently 

For several reasons, quality needs to be managed differently in food production than the way it is done in the manufacturing of goods. 

First, raw materials such as fruit and vegetables differ from item to item, day to day, and crop to crop. If the final produced good is out of spec, it cannot be distilled or disassembled back to its original component parts because those parts do not retain their original identity, as they do with some assembled products. These fundamental chemical and molecular changes in food require a different quality approach.

Food and beverage production also contain conversion processes (e.g., freezing, pasteurization, thickening, and condensing) as well as fabrication processes (canning, bottling). Processed products and the means used to make them differ greatly from assembled products. Distinct characteristics come into play:
1. The homogeneity of the final product means defects spread throughout a unit, as opposed to assembled products, whose defective parts can simply be removed and replaced.
2. The use of a recipe entails the continuous transformation of ingredients without the direct involvement of an operator, and this transformation cannot simply be stopped.
3. Continuous methods in batched production—a specific quantity of material—require uniform character and quality.
4. Consistency in raw materials and measurement is necessary to reduce variability and costs.
5. In the case of sampling, gleaning the most information from the smallest samples is paramount, since the sample cannot be returned to the product line.

Challenges facing food producers today 

The ultimate goal for food producers is to develop a quality system that is rich in customer sensory data, applies exact measurement of raw material qualities, and ensures a production process that is always in control and capable of producing as high a quality of good-tasting foods as possible.

The Juran Institute has been working with the food production industry for many years. We have observed the failures plaguing the industry and have helped clients avoid poor quality by addressing:
• Failure to understand and measure the correct customer sensory characteristics
• Failure to distinguish quality from safety
• Too few quality management staff unskilled in the process and tools to manage quality

Understanding and measuring customer sensory characteristics

Quality management begins with product design—starting with the voice of the customer (VOC).

During the conceptualization phase, the organization’s focus should be to identify customers’ needs and establish objective and measurable specifications to ensure the product delivers what customers want.

The customers include a cast of characters:
• Ultimate users (or eaters)
• Homemaker or restaurateur who purchases the product
• Supermarket or restaurant chain that needs to make money by selling the product
• Regulatory agencies that ensure the food is safe

Each customer has different needs. Every need is critical to the product’s quality characteristics and must be understood, defined, measured, and deployed into the design, production, and distribution chain.

Missing anything that is critical to quality (CTQ) could mean not being able to sell the product because the user did not like it, or it harmed a person because of failure to manage hygiene in the factory.

Product design in the food production industry also relies heavily on research and development (R&D) of a particular technology and not always on the consumer or the cast of customers. Ideally, R&D should work hand in hand with production. One design method designers should all become skilled in is understanding the VOC and how to drive that voice through the design process.

For example, when dealing with recipes, the proportions of the mixture components can be more important than the amount of the individual components. Thus, as the manufacturing process becomes more complex, each component, transfer, or change in conditions is a potential source of failure.

And finally, product design that includes ease of manufacturing results in lower setup time and costs, faster start-up, and higher quality in the finished product. The elements commonly found in manufacturing systems that consistently produce food products of high quality include standardization of components and equipment, simplified recipes and instructions, minimization of handling, mistake-proof processes, and recipes designed to take advantage of physical properties, among other things.

Distinguishing quality from safety

So often I hear that quality means a safe product. Quality and safety are not the same.

A quality product meets all of the important needs of the customer, including taste, price, availability, ease of use, and safety. Safety is all about do no harm. A high-quality product will be safe, but a safe product is not always of high quality. Do not mix them up.

Unfortunately, most of the food safety personnel also manage quality—but they really only manage safety. Why? Because that is what they are required to do.

Unilever, one of the larger food producers, understands that quality and safety are equally important. Paul Pullman, CEO, clearly says what quality is about: “We meet everyday needs for nutrition, hygiene, and personal care with brands that help people feel good, look good, and get more out of life.”

Unilever does this with a robust system to ensure all elements critical to quality and safety are managed effectively and efficiently. As a result, they consistently produce products that taste good and are safe. In the event there is customer dissatisfaction, they fix the product—and fast.

An organization’s “quality professionals” who manage safety and quality must be trained in quality tools and methods such as statistical process control (SPC), VOC, lean, and Six Sigma. As long as they manage safety and produce the product according to the recipe, the product will be of high quality, too.

Developing skilled safety and quality management staff

Quality needs to happen every day and be supervised by trained and certified quality engineers and managers. When untrained personnel oversee quality, the organization builds an unseen risk into the process—that of not knowing how a product is truly performing over time to the CTQs.

Safety personnel who cross over and manage quality are often very skilled in safety regulations and science. However, many of them do not have a deep skill set in quality.

It is essential that food industry organizations review the training and certifications of their staff. Most have many credentials in food safety; many have few credentials in quality. If your organization is one of them, here are some areas where you need to beef up your staff.

Bimbo Bakeries, the largest baked goods company in North America, tackled this issue head on. With consumer giants like Thomas’ English Muffins, Entenmanns, Freihofers, and Arnolds Bakeries, Bimbo needs to produce high-quality and safe product every day. The company defines itself as:
“Trusted brand names in fresh baked foods and a steadfast commitment to quality, freshness, and service are the values behind the success of Bimbo Bakeries USA. Our bakeries produce the finest breads, rolls, buns, tortillas, chips, snack cakes, cookies, donuts, cakes, and pastries under a variety of popular brands that our customers know and love.”

Both Unilever and Bimbo Bakeries accomplish their missions by training and retraining their safety personnel in quality management methods.

What all quality managers in the food industry need to know

We have identified a set of topics that all quality managers in the food industry should be skilled in, not all at once, but based on their roles in the value chain:
1. Customer and shopper, consumer needs and satisfaction
2. Quality standards and good manufacturing practices (GMPs)
3. Quality in warehousing and logistics
4. Hygiene in operations
5. Nonconformance management
6. Quality management system
7. Risk management
8. Safety: hazard analysis and critical control point (HACCP) and failure mode effects and analysis (FMEA)
9. Incident management
10. Quality in design
11. Supplier and third-party quality
12. Data measurement and analysis
13. Improvement methods and tools applications (lean Six Sigma)
14. Quality verification and validation
15. Food industry regulatory requirements

If your organization has had a recent quality or safety issue, it probably was due to a break in your dam—i.e., the systems that were put in place to protect against risk. That break may have had its root cause in a lack of skills needed to maintain the dam.  To avoid the failures, revisit your teams’ skill sets and establish a new path forward. We all need good, safe, and healthy food.

About The Author

Joseph A. De Feo is president and executive coach with Juran. He is recognized worldwide for his training and consulting expertise which enables organizations to achieve superior results. For additional information, visit www.juran.com.

Authored by Tracey King

Rising US healthcare costs, inadequate access, pervasive underinsurance and lagging quality have forced healthcare purchasers to make significant changes in payment methods. The Affordable Care Act (ACA), signed into law in March 2010, brought about one of the largest American health reform initiatives in history. Central to the ACA is value-based purchasing programs. Physicians, hospitals, ambulatory surgery centers, psychiatric hospitals, rehabilitation hospitals and skilled nursing facilities will all be subject to value-based payments (Fraser, Encinosa & Baker, 2010).

At its broadest, VBP basically refers to any purchasing practices aimed at improving the value of healthcare services, where value is a function of both quality and cost (AHRQ, 2002). Value-based purchasing (VBP) programs are being put into place with increasing frequency for the purpose of rewarding providers for meeting performance goals or showing improvement (De Feo, 2011). Over 150 value-based sponsors offering over 250 programs are in place with most sponsored by private sector health insurance and employer purchasing cooperatives (Fraser, Encinosa & Baker, 2010). For hospitals, a percentage of a hospital’s base operating payment for each discharge or diagnosis-related group (DRG) payment is contingent on the hospital’s actual performance on a specific set of measures (Lubell, 2007).

Van Herck et al (2010) conducted a systematic review of the effect, design choices, and context of value-based purchasing in healthcare. Six recommendations that should be taken into account when running a VBP program were supported by evidence throughout 128 studies include:

1. Selecting and defining VBP targets established upon baseline room for improvement.
2. Making use of process and outcome indicators as target measures.
3. Involving stakeholders and communicating the program thoroughly and directly throughout improvement, implementation, and evaluation.
4. Implementing a uniform VBP design across payers.
5. Focusing on quality improvement and achievement. A combination of both is most likely to support acceptance and to direct the incentive to both low and high performing providers.
6. Distributing incentives at the individual level and/or team level.

Other recommendations that were theory based include a refocus of the program when goals are fulfilled with continued monitoring of scores on old targets to sustain the gains, support participation and program effectiveness by means of adequate incentives, and the provision of quality improvement support and tools.

Boards of directors are instrumental in the existence of a quality-driven culture and have become more strategic to address the challenges of healthcare reform and value-based purchasing. Providers and organizations have implemented numerous process redesign initiatives for the measurement, control, value improvement, and cost reduction of healthcare. Quality management methods have spread rapidly throughout the US with a focus on developing a structure to improve performance (De Feo, 2011). To meet the stringent requirements of demonstrating quality through process and outcomes measures, many healthcare organizations have adopted Six Sigma methodology and lean principles to provide a data-driven and disciplined approach to meet value-based purchasing requirements.

The implementation of healthcare reform and value-based purchasing measures present unique challenges for healthcare organizations and individual providers. Through the adoption of Six Sigma methodology and lean principles, organizations are better prepared to implement innovative programs designed to improve performance and overall quality.

Please contact the Juran Institute at Tina@juran.com for more information on Healthcare Reform.

Cancer strikes one in three individuals, but as with anything else, it’s far less daunting when you don’t have to face it alone. Thanks to the Boston Marathon Jimmy Fund Walk to benefit Dana-Farber Cancer Institute, cancer patients and the scientists working to halt the disease for good now have even more support than ever in their courageous fight. As in the past, Juran Institute is doing its part to rally to the cause.

This time around, Joseph M. De Feo–son of Juran President & CEO Joseph A. De Feo–will be participating in the marathon on September 18, in support of the Dana-Farber Cancer Institute and the Jimmy Fund. The funds raised will go toward providing care and conducting groundbreaking research, and we encourage you to help Joseph in his endeavor by visiting his Jimmy Fund Walk web page to make a donation, whatever the amount.

“Cancer touches all of us, and we must stop this disease in its tracks,” said Joseph. “Every dollar I raise is another step along the road to finding cures for cancer. Please support my efforts by giving generously, and help reach the ultimate finish line: a world without cancer. I will be walking in honor of my mom, and all cancer patients that are fighting every day.”

Joseph has currently raised $1,315 of his fundraising goal of $2,000. If you’d like to help him reach that number, head over the Jimmy Fund website and pledge your support now.

As the saying goes, “the only way to eat an elephant is bite by bite.” So begins our most recent article for QualityDigest.com, in which Juran President Joseph A. De Feo, along with Mary Beth Edmond, Jonathan D. Flanders, and James Er Ralston, takes on the very important topic of healthcare in America. Specifically, the article focuses on methods of quality improvement, and how Lean/Six Sigma are helping to revitalize the industry:

In the U.S. healthcare system, quality and safety have developed into strategically important issues. Progress is being made at the local level, even if it is slow and doesn’t get much of the public’s attention. Healthcare improvement has certainly come a long way since the early 1990s, when an improvement resolution took shape, thanks in part to the efforts of the National Demonstration Project on Quality Improvement in Healthcare, with Dr. Don Berwick (then from Harvard Community Health) and Blanton Godfrey, former CEO of Juran Institute. Organizations today are more open to improvement, and to the importance of managing quality.

To read the article in its entirety, proceed to Quality Digest’s website.

Authored by Er Ralston and Ari Park

One of biggest changes occurring in healthcare today is a shift from encounter based care to continuums of care. This change is driven by many factors, including governmental legislation, payer incentives and the recognized need by providers and healthcare systems. The historical lack of coordinated care results in medical errors, unnecessary procedures and other forms of waste. The result for the patient is higher costs, lower quality and unsatisfactory patient experience. A study performed by the Midwest Business Group on Health in collaboration with the Juran Institute revealed that 30% of all health care expenses result from poor quality care. In 2009, total health expenditures in the U.S. were $2.5 trillion. This means that $750 billion was the result of poor quality (MBGH, 2003).

To address these issues, healthcare providers and organizations are learning to better manage continuums of care through the management of Clinical Care Paths. A Clinical Care Path is a map of clinical practice for a particular diagnosis. Clinical Care Paths provide an effective means to apply quality improvement and quality control principles in the health care industry. Effective Clinical Care Paths are designed to eliminate variations in the management of patient treatment by simplifying processes making use of reminders and check lists. Evidence based guidelines are used to guide health professionals in the treatment of patients. Studies have demonstrated that Clinical Care Paths improve clinical outcomes and quality of care (McCabe, Taylor & Wolff, 2004).

Implementation of a pathway begins with a multidisciplinary team whose job is to develop and facilitate the introduction of care guidelines and practices into the day to day operations. Current practice is reviewed and the information is incorporated into the pathway. The process of continuous improvement allows for potential risks to be identified and procedures to be implemented to minimize them. Documentation from team members must be accurate in order to observe any variation from the pathway (Bundred & Kitchiner, 1999). Analysis of variation provides valuable information on improving performance.

Clinical Care Paths also provide information which enable the cost of care to be tracked and managed through continuums of care. They improve clinical outcomes by reducing errors and ineffective practice. They are an essential tool in coordinating and managing clinical resources (Choong et al., 1999). Knowledge in the pathway is always updated through continuous improvement and provides enhanced learning opportunities to new staff of all disciplines. Clinical Care Paths must be centered around the need to improve the quality of care and outcomes. They cannot be regarded purely as a tool to keep costs down.

There are two initiatives to note: 1) Medicare’s Acute Care Episode (ACE) and 2) Geisinger Health System’s Proven Care Initiative. Both of these initiatives set out to become market leaders by improving operational efficiency and quality (Draper, 2011). All organizations that were a part of these initiatives used evidence based medicine for benchmarking the standardization of care protocols and measuring care outcomes. With respect to care management, leaders found that there was a need for improving inpatient care processes between hospitals and physicians. The both initiatives demonstrated that the use of IT can assist care providers with improving processes and information flow. The early finding of these initiatives indicate that full automation of clinical IT tools is integral in realizing the operational changes necessary for successful implementation of bundled payments.

The Juran Care Path Improvement Approach is intended as a guide for health care leaders and improvement practitioners for improving care delivery within clinical care path infrastructures. Improvement opportunities can be found in areas such as total cost care, clinical outcomes, access to timeliness of care and patient satisfaction and loyalty. The guide provides a suggested approach for assessing, selecting and executing improvement opportunities. The Care Path Improvement approach begins with the Pre-Define phase followed by Define, Measure, Analyze, Improve and Control. It is a guide for prioritizing and selecting the care paths and addressing the greatest opportunities within them.

You can contact the Juran Institute at info@juran.com for more information about Juran’s Care Path Improvement Approach.

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References

Bundred, P. & Kitchiner, D., (1999). Clinical pathway: A practical too for specifying, evaluating and improving the quality of clinical practice. The Medical Journal of Australia, 170, 54-55.

Choong, P., Dowsey, M., Kilgour, M. & Santamaria, N. (1999). Clinical pathway in hip and knee arthroplasty: A prospective randomized control study. The Medical Journal of Australia, 170, 59-62.

Draper, A. (2011). Managing bundle payments. Health Care Financial Management, 110-116.

McCabe, J., Taylor, S., Wolff, A. (2004). Using checklists and reminders in clinical pathways to improve hospital inpatient care. The Medical Journal of Australia, 181, p.428-431.

Midwest Business Group on Health, (2003). Reducing the cost of poor-quality health care through responsible purchasing leadership. Chicago: MBGH Publication.

Porter, M., (2010). What is value in health care? The New England Journal of Medicine, 363, 2477-2481.

Ralston, E., Lean service lines in healthcare (2010)

Earlier this year, Juran Institute established two new ways for you to interact with us. Since that time, our Facebook and Twitter presences have become excellent communication tools–and most importantly, the perfect outlets for you to keep up with all things Juran, from the latest news to upcoming products and appearances. It’s also a great way to be instantly informed of the most recent posts to The Big Q Blog.

In addition to news and information on Juran, we also regularly share fascinating and useful items from throughout the world of quality improvement and management.  So if you haven’t already, please feel free to friend us on Facebook, or follow us on Twitter, and join the conversation!

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We’ve talked about CTQs as being ways of measuring the need, but for a true understanding of CTQs, you need to have an understanding of the measure of performance, as well as the desired level of performance. The customer may say, “I need quick delivery of the product.” But if we further clarify what they mean by quick delivery, we could think they mean within a week, but what they really mean is within a day. One of the common mistakes comes from understanding the measurable need, without understanding the desired level of performance.

“Once you determine the CTQs, you then need to convert the customer’s words and behaviors into measurable requirements,” says Joseph A. DeFeo, CEO of Juran and Design for Quality Expert. “Once you discover the customer needs, you then design the features that may deliver the level of functionality that’s expected. We really talk about CTQs being about what functionality we need, and what features we provide. Wanting the product quickly would be the need, but functionality would be a quick shipping method or quick delivery method, and features for doing that could be things like electronic downloads, as a way of providing quick delivery.”

This type of methodology can be applied to a wide range of products and services. Certain CTQs are across the board, and can be found with any product or service you’re dealing with. Almost any product or service has quality needs with regard to defects. Juran uses quality in a different context than just talking about defects, but a lot of defects or errors would fall into one type of classification. A second would be timeliness of delivery. A third category would be value or cost vs. price of the product. And a fourth major category is usually customer service characteristics, like responsiveness.

It’s important to understand the needs not only of the end customer, or the company that’s going to receive and use the product, but also of the internal customers in the delivery cycle. There are customer/supplier relationships all along the way. And so, you may work to meet the needs of some of the internal customers along the way, and sometimes be unable to meet the end customer needs. So it applies not only to the external customer, but to the internal customers as well. The CTQs are essential in both arenas.

“A client was asking me about the context of CTQs in a typical Six Sigma DMAIC project,” says Juran Client Relation Executive (CRE) Er Ralston. “And the reason why it was confusing is most of the time in a Six Sigma DMAIC project, we’ve got a known problem we’re trying to fix, and that problem is tied to some customer need that’s not being met. We usually already have a pretty good understanding of what that need is, or we wouldn’t know it was a problem in the first place. So they asked, ‘What’s the point of going out and gathering all this CTQ information, especially for internal customers, when we know the problem is that we’re shipping defects to the customer?’ In the early stages of an improvement project, if you can understand and do the work to meet customer needs, both internal and external, you may uncover other needs that have to be met in order to meet the end customer goal. This can give you some early indication of what some of the causes of your problem may be, as well as things you can enhance in the process as you go along.”

Click here for Part 1 of Critical to Customer: The Importance of CTQs

One interesting and seemingly paradoxical aspect of dealing with customers has to do with the irrefutable fact that very often there is a difference between what the customer wants versus what they actually need. Most customers have needs such as an automobile being safe, reliable, cost-effective, high miles per gallon, etc. These needs must be understood and converted to CTQs

CTQs are the elements that are critical to meeting customer needs or simply those characteristics of your product or service that are critical to quality. CTQs can apply both to the end customer, as well as internal customers. Determining CTQs is all about the conversion from the voice of the customer to measurable requirements—taking the verbatim comments of customers and translating them into product features that will meet their needs.

Often times, when you ask customers what’s important to them, they answer in a way that provides a hint to what the need is, but may not be the true need. They may answer in the form of a solution, or state a problem, and so the goal of the design team becomes determining what the underlying need is that prompted that response.

All CTQs must be converted to measurable terms that can be quantified by the design team so the organization knows if the needs are being met. If you can quantify, then you’ve got a way to measure your ability to meet that customer need.

Determining the difference between what customers are saying and what the needs actually are is the basis for much of Juran’s emphasis on quality planning. We describe the planning process, or design process, as a universal management technique. The heart of this is the ability to translate customer comments into true needs.

Why is this important, and why is there such a difference between what customers say and what they really need? Customers have preconceived notions of how a need may be met, and often they have good ideas but express them in terms that anticipate a specific solution. For example, they want to purchase Captain Crunch cereal for their children. What they really want is a nutritious breakfast that is easy and fast to provide to children. It is possible a breakfast bar or yogurt will do the trick but they know the children like the Captain!

That’s where innovative design methods come in. Innovation is the process of creating something new to meet the needs of existing customers or potentially new customers. Needs that haven’t been met before. Customers may not even know all the ways that their needs can be met, so they tend to answer the question with limited knowledge. Innovative design methods such as Design for Six Sigma, Quality By Design and Quality Planning all focus on discovering customer and market needs and then finding a means to meet them.

To be truly innovative, it comes down to identifying what the customer expects of a product or service. A CTQ expert would be the one who would convert what they’re expressing to measurable terms. Our experience is taught in Juran Institute’s curricula–the affinity process that captures all of the voices of the customers (stated needs) and translates them into real needs. We use our voice of the customer CTQ matrix to work through that and document it.

Check back later this week for Part 2 of Critical to Customer: The Importance of CTQs.

Since 2002, the Connecticut Center for Advanced Technology (CCAT) has been presenting the Connecticut Quality Symposium, an event bringing together quality professionals from all over the Nutmeg State for the purposes of building new skills and gaining new insights. And this year, Juran Institute is proud to announce that we are an official sponsor of the 10th annual edition, set to take place at Central Connecticut State University on Wednesday, June 15 from 7:30a.m. to 3:45p.m.

Featured speakers at this year’s Connecticut Quality Symposium will include John Watson, Director of Operational Effectiveness for CIGNA Corporation; Jennifer Schneider, VP of Lean & Continuous Improvement at St. Francis Hospital; and Kenneth Dean, Director of Quality Systems for Nestle Purina (Malcolm Baldridge National Quality Award winner.)

We hope to see you there on June 15. For more information on the Symposium, proceed to the CCAT website.

Juran has been thrilled to be a part of the 2011 World Conference on Quality and Improvement (WCQI). Presented every year by ASQ, the conference was held this year in Pittsburgh over a three-day period from May 16 through May 18. We’re proud to announce that all vendors carrying Juran’s Quality Handbook, 6th edition, sold out completely.

For an overview of the keynote speakers from the 2011 WCQI, check out ASQ’s video below:

We look forward to next year’s World Conference in Anaheim, California. You can find information on the 2012 WCQI at the official ASQ website.