Healthcare Customer Satisfaction: More Talk AND More Action Customer satisfaction (Voice of the customer) is a recurrent th...
Thursday, January 10, 2013
Paul Borawski, the CEO of the American Society for Quality and the writer of the blog A View from the Q has written a very interesting entry on the Definition of Quality. It is worth a read [see: http://asq.org/blog/2013/01/how-do-you-define-quality/].
There are lots of definitions around that Paul was able to document in a Future of Quality report in 2011.
As I look at this list, I will tell you that in my opinion many, perhaps most, of the definitions presented are very unhelpful (The pursuit of perfect that never ends; Quality is conscience, Excellence, Quality is the degree of feeling happiness, Quality is the intangible that makes a better world tangible,.). These are phrases that contain nice but meaningless words.
Then there were a few suggestions that were equally unhelpful, but didn’t even bother to include some feel good intention (Quality is what the customer says it is, I know it when I experience it, My total experience of the provider.)
The problem with all these phrases is that none of them express any sense of objective measurability, and as such don’t provide any support for progress for the science or discipline of Qualitology [see: They do nothing to advance study or progress in Qualitology [ see: http://www.medicallaboratoryquality.com/2010/12/science-of-qualitology.html ].
In 1979, Phillip Crosby created a pretty good working (excellent) definition that has by-and-large stood the test of time. His Quality is the Conformance to Requirements has been reworked in a variety of ways, that all express the same concept (Quality is compliance to a specification, or Conformance to requirements, or Meeting customer requirements)
This has proven to be a helpful place to start. In my field, it starts to break down, for several reasons. First, it implies that there is a uniform customer or a common customer need. It assumes that organizations has the flexibility to provide a unique service for each customer. Second, it implies that customer requirements can always be met, and third it implies that we can capture and analyze the degree to which we have met the requirement (think customer satisfaction surveys). I don’t think any of those are generally true statements.
I am not suggesting that the Crosby definition is wrong, or that it should be discard, or even denigrated, but I think in some fields it needs to be adjusted to fit the circumstance better.
With that in mind let me suggest:
Quality is meeting the requirements and expectations in service or product that were committed to.
Hold me responsible to what I commit to do. If I do that then I can say I have Quality performance. If I miss due to over-commitment or under-performance I have detracted from my Quality.
If I told you that I would get your dry-cleaning done by 10:00 AM, then Quality service requires me to have the job done without fault or damage and ready to go by 10:00 AM. You can count on it.
And if I told you it would be ready at 10:00 AM and you come at 09:00 AM and are angry because it is not ready yet, that may be a disappointment, but is not a reflection on the Quality of my service.
If I told you that I would have that urine culture completed by Tuesday morning before 7:00 AM, that means that you can expect to have an accurate quality-controlled and quality-assured interpretable culture report with the appropriate antimicrobial susceptibility results on your computer screen for 07:00 hr rounds.
And if I told you that I would build a bridge for 3.3 Billion dollars that people can drive across safely, and what I provide within time, and under budget a bridge that nearly kills people in a predictable period of poor weather, that is called the Opposite of Quality.
The value of my extension to Crosby’s definition is that it is predicated on to what I made a commitment. If my commitment is not close to meeting customer needs then we have a second issue (more on this later), but I can and should be held to what I commit to do. If I have completed as committed then I can say I have performed a Quality task. If I get it done well, but late, I can measure the degree of lateness (in the laboratory we call that turn-around time) and I can define the amount of Quality lost. I can measure amount of conformance to commitment, and I can study the deviation and develop a specific strategy for improvement.
So in summary my definition for quality is tied to the customer need, but is further refined based on my ability to perform based upon what I promised; it is stateable, and it is measureable, and it is studyable. Mission accomplished.
Not bad, eh?
PS: The planning for the UBC POLQM Quality Conference (October 16-18, 2013) is coming along nicely. The themes of World Standards in Health and Improving medical laboratory services for better consumer care are coming together are established.