Public Health Quality Improvement

The purpose of this book is to introduce the concepts embedded in quality function
deployment (QFD) and Lean-Six Sigma to help Public Health professionals implement quality improvement within their agencies. The tools and techniques of QFD and Lean-Six Sigma are designed to augment a robust PDCA or PDSA problem-solving process, not replace it.
The tools and techniques of QFD and Lean-Six Sigma can help problemsolving teams by providing insight into customer needs and wants, design and development of customer-centric processes, and mapping value streams. Both QFD and Lean-Six Sigma focus on doing the most with the resources we have.
Each of these megatools supports efforts to expand our community support programs
and to increase the effectiveness of internal capacities. This dual external/ internal focus offers an excellent partnership of quality improvement tools for
Public Health.
The tools and techniques of QFD and Lean-Six Sigma can help a problemsolving team make breakthrough improvements by building in customer requirements early in the problem-solving process as well as setting the stage for future improvements. You will fi nd that the QFD process ensures that the voice of the customer (VOC) drives all activities associated with designing or redesigning a product or service for internal or external customers. Lean-Six Sigma uses the same VOC inputs to align every activity within the Public Health department (PHD) directly with stated needs of the community and its stakeholders. These two methodologies will help improve quality, costs, and timeliness of products and services, which in for-profi t businesses translates into increased profi tability.
In Public Health, having lower costs can mean more can be done with existing budget dollars.
The objectives of QFD and Lean-Six Sigma are as follows:

• Provide higher-quality products and services to customers.
• Achieve customer-driven design of these products and services by
converting user needs into design parameters.
• Provide documentation and tracking system for future design endeavors
• Develop delivery processes that are effi cient and effective
• Involve suppliers early in the process
• Require data-driven decision making and incorporate a comprehensive set of quality tools under a powerful framework for effective problemsolving
• Provide tools for analyzing process fl ow and delay times at each activity in a process

The early results of the use of QFD in the United States included a reduction in the cycle time for design work, a defi ning of quality early in the design stage, a decrease in quality problems during manufacturing, a way to objectively benchmark
against the competition on improvements, reduced warranty claims, and an improvement in cross-functional team work.
In this book we will modify the QFD process and Lean-Six Sigma methodology so they are aligned with the needs and differences in Public Health design and delivery of products and services. When we make modifi cations we will point this out so readers will understand the change from what might be seen in an industrial or healthcare application of the same concepts.

As the Public Health community expands its use of quality improvement (QI), there is often confusion about how all the tools, techniques, methodologies, models, and approaches fi t together.1 Available techniques include basic and advanced tools of quality improvement as well as several QI models including quality function deployment, Lean-Six Sigma, daily management, mobilizing for action through planning and partnerships (MAPP),2 turning point,3 Baldrige,4 and state quality award models. At times, these models are introduced as competing techniques and processes. The models are not tied together into a system by which they complement one another. This chapter provides an overview showing how various QI techniques and improvement models are related to one another and can be used in compatible ways. The Public Health community would benefit from an overall approach that completely integrates QI into its management practices. Continuous improvement is one component of an integrated system of performance management by which an organization meets and exceeds the needs and expectations of its multiple customer, client, and stakeholder communities.
Some of the ways in which performance management can positively influence a Public Health agency are:

• Better return on dollars invested in health
• Greater accountability for funding and increases in the public’s trust
• Reduced duplication of efforts
• Better understanding of Public Health accomplishments and priorities among employees, partners, and the public
• Increased sense of cooperation and teamwork
• Increased emphasis on quality, rather than quantity
• Improved problem solving5

Autores:The Public Health Quality Improvement Handbook,
by Ron Bialek, Grace L. Duffy, and John W. Moran