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Evolution of quality improvement

The quality movement can trace its roots back to medieval Europe, where craftsmen began organising into unions called guilds in the late 13th century.

From craftsmen to the industrial revolution

Until the early 19th century, manufacturing in the industrialized world tended to follow this craftsmanship model. The factory system, with its emphasis on product inspection, started in Great Britain in the mid-1750s and grew into the industrial revolution in the early 1800s.

In the early 20th century, manufacturers began to include quality processes in quality practices.

The war effort

After the United States entered World War II, quality became a critical component of the war effort: bullets manufactured in one state, for example, had to work consistently in rifles made in another. The armed forces initially inspected virtually every unit of product; then to simplify and speed up this process without compromising safety, the military began to use sampling techniques for inspection, aided by the publication of military-specification standards and training courses in Walter Shewhart’s statistical process control techniques.

The Japanese quality revolution

The birth of total quality in the US came as a direct response to the quality revolution in Japan following World War II. The Japanese welcomed the input of Americans Joseph M. Juran and W. Edwards Deming and, rather than concentrating on inspection, focused on improving all organisational processes through the people who used them.

Total Quality Management

By the 1970s, US industrial sectors such as automobiles and electronics had been overtaken by the Japanese manufacturing industry as quality leaders. The US response, emphasising not only statistics but approaches that embraced the entire organisation, became known as Total Quality Management (TQM).

Beyond manufacturing

In the last couple of decades, new quality systems have evolved from the foundations of Deming, Juran and the early Japanese practitioners of quality. The concept of quality has now moved beyond manufacturing into service, healthcare, education and government sectors.

While there are many different quality improvement methodologies, the evidence suggests that it is more important to pick an organisational approach and stick with it for many years. Many of the methods, such as the Model for Improvement (IHI), Lean (based on the Toyota production system) or Six-Sigma, have common ancestry and often utilise similar concepts such as rapid-cycle iterative testing through the Plan-Do-Study-Act cycle.

Quality improvement in healthcare

Additionally, in healthcare, quality improvement (QI) methods are also evolving to think about how to maximise the ability of the teams nearest the patient to deliver quality improvements (Microsystem theories, Human Factors), how to improve patient flow (Theory of Constraints, Modelling and Simulation) and how to best involve the public and patients in co-design and production of services and self-management (Experienced Based Co-design, Co-production).

Thanks to Dr Amar Shah, Associate Medical Director (Quality Improvement) & Consultant Forensic Psychiatrist, East London NHS Foundation Trust – qi.elft.nhs.uk

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