Continuous Quality Improvement: Origins, Concepts, Problems, and Applications

Abstract

Continuous quality improvement (CQI) is a management philosophy and method that is employed widely in various settings. Japanese industry first utilized CQI in the 1950s based on advice from American consultants. The quality of Japanese goods dramatically improved. American industry, health care organizations, and, more currently, educational institutions are employing CQI in different capacities. The CQI approach is positive as most problems are related to the way things are done (process) and not faulty individual effort. CQI encourages trust, respect, communication, collaboration, responsibility, empowerment, and recognition between employees and management (leaders). CQI vigorously discourages fear and blame. Successful implementation of CQI is an arduous, long-term change in the culture of an organization that requires the financial and emotional commitment of leaders. Leaders may have to learn to share power, educate, be able to admit ignorance, know when to intervene, and learn on the job. All participants (stakeholders) need to have constructive input with some positive feeling to jointly develop mission, vision and value statements, and guiding principles of expected behavior. Satisfaction of all people (customers) determines quality. Customers are both internal (e.g., employees, management) and external (e.g., community, purchasers, suppliers) to an organization. Quality is quality of kind or that which exceeds customer expectations. Attainment of quality is an ongoing (continuous) process. CQI requires functional teams and utilizes the team approach to critically assess process and to devise solutions to problems and new products. Teams have numerous intangible and tangible tools for function and assessment. The Plan-Do-Check-Act cycle or an alternative methodology is employed in process analysis, problem solving, and implementation of solutions. The ability to trust and thus more completely interact with others (interdependence) is a desirable characteristic to serve as an individual basis for CQI. Integrating CQI into the competing spheres (work, personal, family, spiritual) of an already stressful life may be difficult. However, balancing these spheres with the help of employers should be important to CQI. CQI may have applications in physician assistant and other environments.