Continuous Improvement Quality Program for a Wellness Clinic

Summary and Recommendations

“In today’s competitive environment, companies are intensely concerned with quality of products and services, where a successful organization is one which is constantly improving quality in every area of their organization” Heizer & Rende, 1999).One pervasive and lest recognized problems experienced by businesses all over the world in this day and age is the lack of product or service conformance to pre determined specifications or requirements. A large number of businesses today run under a system of ‘rework’ where company systems and processes of out put are continuously repeated to get the job done right after a couple of tries instead of getting it done right the first time. Continuous quality improvement is an ongoing process to improve services, products or systems through either a one time break through improvement processes or an incremental improvement process over time. Adapting continuous quality improvement programs for an organization help cut instances of rework such as those mentioned above through process, system or service designs developed by continuous quality improvement mechanisms. Quality improvement tools include six-sigma; which is a fact based philosophy of quality improvement that values prevention of product or service non conformance or defects over detection, lean, total quality management and PDCA or plan-do-check-act cycle’s, also called Shewhart or Deming cycles. “Six-sigma quality prevention tools support competitive advantage by minimizing the number of variations and amount of waste while driving customer satisfaction and bottom line results” (Day, 1993).

This paper explores the steps involved in developing a continuous quality improvement program for a wellness clinic. The paper also goes on to name integral processes vital for the success of businesses in today’s dynamic world.

Problem Situation

When a doctor examines a sick child with red spots, a high temperature and a sibling who has the measles, it is not essential for one to be “Loise Pasteure” to make a judgment on what the problem could be. Identifying companies with big quality predicaments has some what the same degree of difficulty. Customer dissatisfaction in this instance is the quality dilemma.

According to Philip B. Crosby there are several characteristics that troubled organizations have in common. The first of these characteristics is the case of out going services normally containing deviations from the published, announced or agreed upon requirements (Crosby, 1984). This refers to businesses in the service industry not usually documenting their non conformance as formally as product companies do. In so doing such businesses encouraging a situation where no conformance is the norm, which in turn ultimately produces a consistent flow of problems.

Another symptom listed by Crosby as leading to the fall of organizations from their earlier high performance status is the aspect of management neglecting to evolve by taking in to consideration the dynamic changes taking place in the world they function in. “No matter how effectively a company meets the preliminary needs of its customers, it must stay constantly alert and responsive to its customers’ continuing wants and needs. If the company is not responsive to these changing needs, the passage of time will erode its earlier advantage” (Day, 1993).

As per the given continuous improvement assignment, the task of this paper is to comprehensively present and illustration the use of continuous quality improvement systems in the service industry. To carry out this task I decided to take the health care industry to draw examples on how continuous quality improvement can be managed in this service sector.


In an article in the Harvard Business review, David A. Garvin discussed the idea of abandoning the historical view of quality as measuring parts and managing defects. He comments: “To achieve quality gains I believe managers need a new way of thinking, a conceptual bridge to the customer’s vantage point… high quality means pleasing customers and not just protecting them from annoyances… managers need to take a more preliminary step – a crucial one however obvious it may seem. They must first develop a clear vocabulary with which to discuss quality and strategy. They must then break down the word quality in to manageable parts that allow for continuous redesign or improvements” (Garvin, 1987).

David Garvin then goes on to propose critical categories that can serve as a framework for quality analysis in continuous quality improvement. “He lists these dimensions as durability, aesthetics, performance, perceived quality, conformance, serviceability and features” (Garvin, 1987). Of course not all categories listed apply the same way for both the service industry and product industry. However they do offer a good guideline in terms of what or where to start.


In order to develop a continuous quality improvement program for either service related or manufacturing related enterprise the term quality must be defined in light of the continuous improvement program. According to the Japanese, continuous improvement or “Kaizen” as it is known in the Japanese’s language refers to “the slow, incremental but constant improvement of something” (Alukal & Manos, 2006). “Kaizen” is a continuous quality improvement system that involves every employee in an organization. From the cleaning crew to upper level management, each person within the organization is urged to developed enhancement proposals regularly. “This practice is not a yearly or monthly activity but a continuous one with Japanese employees from companies such as Toyota and Cannon developing 60 -70 individual suggestions each year” (Heizer & Render, 1999).

Problem Statement

“A customer is the most important person ever in this office – in person or by email. A customer is not dependent on us; we are dependent on him or her. A customer is not a disruption to our work; he is the purpose of it. We are not doing him a favor by serving him; he is doing us a favor…” (L.L. Bean Poster)

It is impossible to avoid the constant bombardment of “quality” and “satisfaction“ messages in advertising, on the television and in print media. However, much of this advertising of actions to deliver the product or service is little more than vague rhetoric. Even popular phases such as “satisfaction guaranteed” do not state what the customer is to get from his or her purchases. Although some companies have attempted to improve this rhetoric by supplementing the message with addition definitions of satisfaction – For instance”McDonalds pledge to its customers ‘if you’re not satisfied we’ll make it right the’ or ‘the next meal is on us’ does not define what make it right means, leading customers to question whether this guarantee relates to the product quality and customer satisfaction or whether it’s merely a promotional affair” (Ross, 1999).

From our class lecture notes and my keen observations of business related surroundings it is clear to me that customers define quality in terms of their total experiences with a company. Though it is clear from my research findings, most companies attack consumer satisfaction in a constricted way by restricting thought to only the service. As such this paper’s main purpose is aimed at solving such problems in the service sector (in this case the health care industry) by coming up with a whole rounded continuous quality improvement program for “The Well Person Health Care Clinic” using the continuous improvement strategies, tools and techniques learned from class.

Problem Solution: Continuous Quality Improvement Program for the Well Persons Health Care Clinic

Continuous improvement refers to an organization’s ability to endlessly improve on its existing systems or processes. In order to discover new and better ways of doing things, this principle can be implemented or applied through a policy of maximizing research, creative imagination and experimentation. Bellow is a program description that can be applied for continuous quality improvement in the health care sector.

Mission, vision and Quality goals

  • Introduction: The first step in developing a continuous quality improvement program for The Well Persons Health Care clinic is to define the mission, vision and scope of services for the clinic.
  • Mission: The Well Persons Health Care Clinic mission is to give prompt and considerate health care services to patients and their families by providing the utmost achievable standards through providing top qualified staff, leading health care equipment and dynamic staff training programs. The clinic also seeks to find avenues to control its cost of operations such that the cost of health care service charges to patients stay at low and affordable rate to as many patients as possible without compromising the clinic’s practicality, its employees and investments.
  • Vision Statement: The Well Persons Health care clinic strives to achieve the status of being the premier health care providers in the country and region by benchmarking itself against the highest attainable international standards by seeking continuous quality improvement.
  • Quality Objectives: The Clinic’s quality goals are to persistently improve patient satisfaction by providing timeliness in services provided and offering effective services in a safe, recipient centered, unbiased way to meet client’s needs. The Well Persons Health Care Clinic is dedicated to continuously improving quality of health care their customers receive by ensuring that: treatment offered to clients integrates effective evidence based practices, that clients receive services and treatments that are fitting to each of their needs when available and required, risks and errors in service provision to customers may be avoided, eliminated or prevented, that costumer expectations and needs are valued; with customers or patents being provided with the opportunity to take part in the decision-making process on their treatment and ensuring that services are given with care and sensitivity with treatment and procedures being carried out on time with uninterrupted coördination..

Quality improvement principles

“Continuous quality improvement is methodical approach to assessing services and improving on them using prioritization as a basis” (Deming, 1994). The Well Persons Health Care Clinic approaches measuring performance for continuous quality improvements base on the flowing principles:

  • Client Focus: The Well Persons Health Care Clinic focuses on meeting and exceeding both its interval and external clients’ expectations.
  • Employee Empowerment: It’s a well know fact that organizations are only as good as the people who make it up, so the Well Persons Clinic uses effective programs that enable employees at all levels involvement in improving the clinic’s quality.
  • Recovery Oriented: The Well Persons Clinic treatments, procedures and service are identified by the clinics commitment to up hold and promote good health by allowing flexibility and choice to offer person centered services and meet individual customer defined goals.

Leadership involvement

The Well Persons Clinic recognizes the need for strong leadership, support and direction in order for there to be quality in its services. As a result the clinic has well established leadership systems which help govern how leadership is used formally and informally through out the organization. “The bases and manner in which key decisions reached are communicated and carried out is outlined in a mechanism that reinforces values, practices, and behaviors in decision-making, choice and development of leaders and managers” (Baldrige Award Criteria, 1999).

  • Prevention over correction: Philip B. Crosby writes that “individuals spend a life time with an organization or company and retire content, never having done anything but ‘rework’” (Crosby, 1984). The Well Persons Clinic utilizes continuous quality improvement to design good processes that meet the right outcomes at the first go than indulge in “rework” or fix processes after non conformance.
  • Measure of performance: The Well Persons Clinic employs statistical tools such “as pareto chats, histograms, run charts, control charts, cause and effect diagrams and flow charts” (Hogan & Cuomo, 2011) to aid in the understanding of the continuous quality improvement needs of the clinic. These tools help the clinic to turn data into information that helps design new systems or change existing ones that allow for higher quality service provision; enabling the Well Persons Clinic to meet its goals and objectives.
  • Data informed practice: The Well Persons clinic uses quality improvement processes that generate feedback loops using collected observations to update practices and measure results as decisions made based of facts are far likely right than those made on assumptions.
  • Recommendations for different processes: Kaizen the use of the Japanese continuous improvement method where all employees are required to offer their personal recommendations or suggestions in the areas and techniques they feel will help improve the continuous quality improvement process of the clinic can be implemented. In addition to Kaizen, other processes or tools that may be used in continuous quality improvement program for the Well Persons clinic include six-sigma, the Deming or Shewhart cycle and poke yoke or mistake proofing. Although poke yoke or mistake proofing is most used in the manufacturing or product industry, service industries such as the wellness clinic can use this approach by predicting and preventing customer error in task treatment and service tangibles.
  • Continuous improvement activities: Structured and Methodical frameworks for quality improvement allow companies to develop continuous quality development actions. The continuous improvement framework implemented by the clinic is well received, understood, and applied by the clinic because of the performance improvement involvement and education given to employees of all levels within the clinic. The clinic’s continuous improvement activities involve: collecting, measuring and evaluating data on the performance of services offered by the clinic and carrying out quality improvement initiatives such as improvement of existing services by modifying processes or creating new services. Tools used in the continuous quality improvement process are explained on in appendix A.

Leadership and organization

Leadership commitment is a key element essential for the success of the clinics continuous improvement processes. The Well Persons clinic provides support to continuous quality improvement activates through its Quality improvement committee and support offered from Board of Directors. The quality improvement committee is responsibly for coming up with the and improving the clinic’s quality improvement program, setting up measurable goals, developing indicators of quality, establishing and aiding specific quality improvement proposal, updating the clinic’s Board of Directors on quality improvement activities and formally adopting a Plan-Do-Check-Act approach to continuous quality improvement. In addition to providing leadership for continuous improvement, the Board of Directors guide and support quality improvement activities by occasionally appraising and approving the clinic’s continuous improvement program.

Goals and objectives

Subsequent to the continuous improvement committee identifying and describing specific aims to be met, the aims are applied as points in the service delivery series where more detailed quality requirements are to occur. This criteria used in identifying goals and objectives is based on feedback from data collection tools used in the continuous improvement process. Some examples of the Well Persons clinic goals or objectives include: Education goals e.g. support staff; clinician and managers will undergo quality improvement training by 10th May, 2011 and Quantitative measurement objective e.g. to cut the general number of employee abscesses by 50% from its current number within a period of 6 months.

Performance measurement

Is “the process of regularly assessing results produced by the continuous quality improvement program” (Hogan & Cuomo, 2011). This involves identification of systems, processes and outcomes that are vital for performance of service delivers systems… Continuous quality improvement involves taking required actions based on data analysis results and opportunities for performance identified (Hogan & Cuomo, 2011)

Characteristic of performance indicators

Elements considered in determining performance indicators for the Well Persons Clinic include consumer inclination which refers to the degree in which an indicator considers group or individual preferences, for instance religion, race or culture; Resource availability which refers to the relationship between costs involved such as available employee resources and the results of the indicator, scientific foundation, validity and meaningfulness. Performance indicators may also be selected taking in to consideration factors such as relevance to mission and clinical importance.

Data collection and analysis methods: information on how to improve services and customers satisfaction can be collected using: focus groups, comment cards, compliant analysis, internet monitoring, direct client contact and formal surveys. The purpose of formal surveys is to find out customer requirements so that efficient and effective quality improvement designs, processes or systems can be implemented; resulting in customer’s satisfaction or delight.

Assessment of performance indicators is carried out by comparing actual performances along pre-established standards i.e. goals and objectives, data on evidence based practice and self over time.


At the end of the year a continuous quality improvement evaluation is submitted. This evaluation sum up a brief description of progress made in meeting annual quality objective or goals in relation to training and provides a summary of results of the pointers used during the year. The last step in the evaluation process is to recommend actions needed to improve the effectiveness of the program.

Monitoring and testing program

Feedback is important is an important element in the success of any continuous quality improvement program. As such the clinic’s quality improvement committee has a well developed system through which quality circles (i.e. employee groups established to meet periodically to the organizations quality related problems and develop solutions) meet periodically to asses the progress to quality systems, processes and services being implemented. Members of the quality circle are also used in the testing processes of new programs. However in cases where the organization does not have quality circles, top management exercises its authority to choose a department used to test new quality programs.


Economic consequences of the recommended program vary from: prevention costs, internal failure costs, appraisal costs and external failure costs. The economic cost of quality may simply be defined as an account of all company costs on producing of poor quality products or low standard services. Costs associated with avoiding poor quality or incurred because of poor quality are also called cost of quality expenses.

More often than not top management in most organization is more concerned with the bottom line than producing quality product or services for their consumers. Though this may seem to cut cost and increase output in the short run, management officials often forget or fail to realize that it is done at a higher cost to the company than they assume. The 1:10:100 rule tells us that $1.00 spent on presentation saves $10.00 spent on appraisals and $100.00 in failure. The Board of Directors at Well Persons Health Care Clinic understand that quality problems directly affect a companies expenses by adding to internal and external failure costs to prevention and appraisal costs.

Prevention cost in total quality management refers to money spent by the company in trying to prevent cost brought about due to the companies products or services having defects or not conforming to established requirements. Prevention cost can further be categorized into quality planning costs, information, system costs and training and general management costs. These costs make up the 1 in the 1:10:100 rules, meaning if organizations invest properly in them, they will be less likely required to spend a lot on appraisals and failure costs.

An appraisals cost is a term used to refers to money spent by a company or organization to check on their processes, systems and services. This is done by measuring and analyzing data or information to make sure that there this conformance to established requirements and no defects are present. Instrument costs, process measurement costs an test and inspection cost are covered under this category. Appraisal costs represent the 10 in the 1:10:100 ratio.

Internal failure costs are all the costs or expenses associated with unsatisfactory quality found before a product reaches the customer. Examples of such cost with regards to the Well Persons Health Care Clinic include: misplacement of a patients file or failure of medical equipment. The categories in this are: scarp and rework cost, costs of corrective action and process failure costs.

External failure costs are all those cost or expense that a company or organization incurs because of having to correct defective products or poor service that have already reached the customer. Expense brought bout due to customer complaints, product recalls, cost and warranty claims and product liability costs resulting in legal actions and settlements make up the bulk of Cost of Quality expenses within this category.

Addition costs that are not as oblivious as the ones mentioned above but fall under the Cost of Quality group are expenses associated with market loss, lost customers, excess overtime due to time spent on redoing work, absenteeism and low moral.


Alukal, G & Manos, A. (2006). Lean Kaizen: A simplified approach to process improvement. ASQ Quality Press.

Baldrige Award Criteria. (1999). Criterion 1.1 of the 1999 Baldrige Award criteria. Web.

Crosby, P. (1984). Quality without tears: The art of hassle-free management. New York: McGraw International Editions.

Day, R. (1993). Quality function deployment: Linking a company with its customers. ASQC Quality Press.

Deming, E. (1994). Quality and the required style of management: The need for change. Journal for Quality and participation.

Garvin, David A. (1987). Competing on the eight dimensions of quality. Harvard Business Review: 101-109.

Heizer, J., & Render B. (1999). “Operations Management.” 5th ed. New Jersey: Prentice Hall.

Hogan, M. & Cuomo A. (2011). Quality improvement plan. Web.

Ross, J. (1999). Total quality management: Text cases and readings. 3rd ed. Boca Raton: Lucie Press.

Appendix A: Quality Improvement Tools

Quality Improvement Tools

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