Sunday, June 25, 2023

The renaming of Quality Improvement?


I have had the opportunity to be actively involved with the American Society for Quality (ASQ).  I am the current Chair of the Healthcare Quality and Improvement Committee (HQIC).  I truly enjoy being  actively involved  because Healthcare Quality has become a personal passion.  Through HQIC I collaborate with like-minded people with a similar sense of passion. 

Last month the World Conference on Quality and Improvement was held in Philadelphia.  Unfortunately, I missed it because of another commitment.  Next year. 

But wait a second… in the last 3 sentences I used a phrase “Quality and Improvement” twice.  Prior to the last little while, I don’t think I have ever said or written Quality AND Improvement before.  I have talked and taught for years about Quality Improvement and Continual Quality Improvement and Continuous Quality Improvement, but never has the phrase Quality AND Improvement been part of that process.   Joseph Juran wrote volumes about Quality Improvement as did W. Edwards Deming, and Philip Crosby and while all of them were involved in ASQ they never used the interloping AND.

So where did it come from?

In 1947 the American Society for Quality Control (ASQC) was created as a union of some seven small organizations.   Each year they would hold an annual meeting (the ASQC Congress).

In 1997, on the 50th anniversary of ASQC, the name of the organization was shorted to American Society for Quality (ASQ), I imagine because the organization appreciated that Quality had become more diverse and involved many more aspects than just Quality Control.

Along with the conference name change, the  meeting name similarly changed to Annual ASQ Congress.

Then eight years later in 2004, ASQ joined forces with several Quality organizations for other countries around the world, and they collectively decided there was value in merging all their congresses into a single world event which they called the World Congress on Quality AND Improvement;  and the interloping "AND" first appeared!

I wonder perhaps that was done to accommodate a common English translation for a conference including primary English and non-English speaking  countries.

In any event, jump forward anther 15 years to 2019, the ASQ goes through another modernizing name exercise.  Within the Healthcare Division there is a committee named Healthcare Technical Committee that needed a name revision.  They decided that a good name would  not be Healthcare Quality Improvement Committee (HQIC) but rather Healthcare Quality and Improvement Committee, still with the acronym HQIC.   

I don’t think any other committee in ASQ followed a similar path.   I did a global check of and found only one reference to an ASQ Committee with the phrase Quality and Improvement in its title, the aforementioned HQIC

Five years ago is not that long ago, however none of the people I have asked can remember why they opted for Quality AND Improvement.  Was there an ASQ organizational directive (now lost and forgotten) that recommended that all committees addressing Quality Improvement harmonize  their names with the conference name? 

So in the absence of a human memory, I decided to go the non-human route,  specifically  ChatGPT.  If AI doesn’t know the answer, then no answer exists.

So I asked the following… “What is the difference between ‘Quality Improvement’  and ‘Quality AND Improvement’? and in about 2 seconds, I got the following:

"Quality improvement" is a systematic, formal approach to the analysis of performance and efforts to improve it. In healthcare, for instance, it involves methodologies to improve care, patient outcomes, and other systems processes with an aim to reduce errors.

On the other hand, "quality and improvement" isn't a recognized term in the same sense but can be understood literally. It refers to the two distinct concepts of "quality" (the standard of something as measured against other things of a similar kind) and "improvement" (the act of making something better). This phrase might be used in a general context where one is talking about both the quality of something and the improvement of something, but they may not necessarily be related.

In my opinion this is an amazingly intuitive and nuanced response.  Scary that it comes from a machine.   Even if it is only the computations of a non-thinking machine, I don’t think it can be disregarded.  Somewhere in its algorithm  the machine recognized that Quality and Improvement are two separate processes that can function either together or  independently.  Just because an organization implements a Quality Improvement exercise doesn’t necessarily ensure there will be a measurable or meaningful improvement in the organization's  Quality. 

Seems to me there are two explanations for the interloping "AND"; either the folks back in that meeting in 2019 were truly visionary and  insightful, or it was a typographical error that never got caught. 

Or maybe they were just being smart alecs.

What I find interesting is that the term Quality and Improvement rings true in my ear, and I find the argument of recognizing the two activities as distinct compelling.  Maybe it is time for all references to Quality Improvement to adjust to the new AI standard.

I suspect Joseph and Edwards and Philip would enjoy the discussion.

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