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Quality function deployment as applied to a health care system
Computers ind. Engng VoL 31, No. 1/2,pp. 443 -446,1996 Copyright@ 1996 ElsevierScienceLtd Printed in GreatB~tai~ All ~ightsm~-rved
Pergamon S0360-8352(96) 00171-4
0360-8352~96$15.03+ 0.00
QUALITY FUNCTION DEPLOYMENT AS APPLIED TO A HEALTH CARE SYSTEM
R. Radharamanan and Leoni P. Godoy Department of Industrial Engineering, Federal University of Santa Maria Santa Maria (RS), 97119-900, Brazil
ABSTRACT Quality Function Deployment (QFD) is used in a health care system to deploy the voices of the customers in understanding their requirements and to include them for continuous improvement of quality in s~'vices provided.
KEYWORDS Quality function deployment, quality in services, health care system, continuous improvement.
INTRODUCTION At present, health care industries throughout the world are struggling with the challenges of setting up economic ways and means of satisfying the human wants for health care services (Sioen, 1994). It is important to emphasize that Broil spends less in health care according to the standards followed in the developing countries, and the worst, spends bad as per the conclusions drawn by the world bank in its 1993 report on world development. The University Hospital in Santa Maria, (UHSM) has its justification for its existence with the community since it attends the health care requirements of the people. Here, one depends on the other for survival. The UHSM needs to have relations with the community, evaluate their requirements, and must lake into consideration their expectations to he prepared to attend them properly. The hospital guarantees its quality of service to satisfy or to exceed the expectations and requirements of its external (patients) and internal (employees) customers (Godoy and Radharamanan, 1995). The UHSM is one of the most complex reality enterprise and its principal objective is to attend the health care requirements of the community. In this paper, QFD ts used to deploy the voices of the customers and understand better their requirements to include them for continuous improvement of quality in ~ c e s provided by the UHSM.
QUALITY FUNCTION DEPLOYMENT FOR HEALTH CARE SYSTEM Figure 1 h the matrix prepared by combining the demanded quality deployment chart and the qualily element deployment chart. This shows the correlation of results between Ihe t~nanded items and the quality elements. Figure 2 shows the quality element deph~r_~nt chart, as a function of executed services identifying the hospital activity factors (Akao, 1990). In Figure 3 the importance of these patients demancL~ have been ranked ba~qxl on their experience and interaction with the current patient ba~. The rating scale is: 1 Very low importance; 2 Low importance; 3 Some importance; 4 Important; and 5 Very important to the patient. Service point can be characterized as follows with the ratings indicated: well attended 1.5; attended satisfactorily 1.2; and poorly attended 1.0 (Shin& 1991). Figure 4 shows the partial structure of house of quality translating the UHSM patients requisites into requisites for improving the 443
19th International Conference on Computers and Industrial Engineering
444
service provided. The patients requisites are the negative and positive critics through complaints. Identify the requisites and take to the relation matrix to find out one of the following relations - strong, mild, or weak - using the symbols given in Figure 4.
Demanded Items I st level
2nd level
3rd level
Quality Elements
l'ralned and Good attitude reception Kind attitude and easy access ~atisfted in serving to hospital ,'mployees the patients ~esponse time Immediate attention and effective service '.lean room Bed adapted to the needs, clean bed cloths etc. Environment Quiet room, pleasing and silent environment Information Information about meals, payment, and visiting time Meals Served at convenient times, warm, variety, and in sufficient quantity Employees Attentive, competent, calm, and fa~t Fig. 1 Quality Elements in the University Hospital in Santa Maria, UHSM
1st level
2nd level
3rd level
Degree of Hospital Service
Degree of )egree of service at service at he reception Lhepatients room
12 3 4
56789
iDegree of IDegree of Degree of service at is~'vice in attention in the informa- meals served employees tion desk
10 11 12
13 14 15
16 17 18
Degree of information after discharge
19 20 21
where: 1. Pleasing reception; 2. More waiting time in the queue; 3. Degree of information; 4. Degree of immediate attention; 5. Degree of cordiality and kindness; 6. Degree of general cleanliness in the room; 7. Degree of ventilation and illumination; 8. Degree of calmness and silence; 9. Degree of insects contamination (cockroaches, flies and mosquitoes); 10. Degree of communication with persons from the nurse ward; 11. Degree of promptness; 12. Degree of information about the treatment offered; 13. Degree of convenience of meals time; 14. Degree of meals quality, warm and variety; 15. Degree of meals quantity served; 16. Degree of attention and competence of hospital employees; 17. Degree of general services in the hospital; 18. Degree of patients value during hospitalization; 19. Degree of information about the treatment to be given at home; 20. Degree of waiting for consulting after discharge; 21. Degree of return to hospital. Fig. 2 Quality Elements Deployment for the UHSM Services
19th International Conference on Computers and Industrial Engineering
Pl~m~
ImporUmce ~AI 5
Quick
R~ponsc Clean Room Good Communication Quality
Hospital Now
Plan
Ratio of Improv~nt
445
Service Point
Absolute Weight
Demanded Weight
Io)
(E)
3
(P) 5
1,67
(c 1 ],2
10,02
15
5
2
5
2,50
1,0
12,50
19
4
3
4
1,33
1,2
6,38
10
4
3
4
1,33
1,5
7,98
12
5
3
5
1,67
1,2
10,02
!5
5
4
5
1,25
1,5
9,38
14
4
2
4
2
1,2
9,60
15
Total
65,88
M~Is
Proper Treatmeat Follow-up
D
=
A
x
B
x
C
;
P
B
N
;
D
E
~
100
x
Total
Fig. 3 Quality Characteristic Weight
Ouait~l ~,, Tagal¢ ~.~? '
~
~ -~
~
~ity
,\ ~
1st
Degr¢~of completoness
1¢v¢1
o f Hospital Scxvic¢
2rid
13~-g. of customer scrvie,e
level
provided by the Hospital
3rd level
\
= ~, ~ =~.~= ~=
___o ~,,
~
Meals - Service Quality =
-
-
Satisfaction
~ <
o
o '~
~-
\-o
Pleasing Reception P~! ~ Quick ~" ~ Response
15 19
o Clean
,o
= ~c,o o ~ c o ~
~2
~= "i U0a~ •-
/30 o/Q,!O/ /36/~/36
o/ //36
A,./ O / O,,,/ A , / O,,. / i/15 /'45 //45 ./15 /'45
15
Proper 14 Treatment 7ollow - up 15 lfier discharge Note:
O/ /45
O//
~.~ ~oom = ~cation ~ Quality
O,/
o/"
.
//42
/i2~ A/A
A/
Q/
/15
,/45
"..'
/15 /15
@ Strong relation (9) 0 Normal relation (3) A Weak relation (I)
Figure 4 Quality Chart (Partial)
446
19th International Conference on Computers and Industrial Engineering RESULTS AND DISCUSSIONS
The results have been analyzed as a function of: patients reception when they arrive at hospital, the room environment where they are hospitalized when treatment is needed with specialized professional assistance, the meals quality, and the assistance from the nurse ward. These four types of benefits that are obtained with the house of quality identify opportunities for future improvements and encourage programs for improving service quality in the health care systems. With regard to the understanding of the necessities of the patients, the results obtained show thai there exists really a lack of information, principally in admitting patients in the hospital. Other problem that appears is the lime spent by the patient in the "waiting room", before attended by the doctor. There are many critics made about the waiting time in the doctor's consulting room in the hospital. With regard to the room the complaints are about the p r ~ t c e of insects principally during the warm seasons. Other information obtained was aboul the meals, many times served cold, but quantity served is sufficient. There were no complaints about the nurses. They are always in contact with the patients and try to transmit the information clearly about the treatment.
CONCLUSIONS The functions of the hospital are sufficiently known and outspread. However, the functions are not always performed to the necessities which involve the eff'w~cy of the service. This happens because the economic structure of the country does not accompany the population growth. It is verified that the resources and the investments in the health care do not satisfy the necessities of the clients. To correspond to the increasing demand of quality, there exists necessity of constant modernization of the health care system In the public organizations, there exist certain opposing points in obtaining the service quality that are not coi-tiii-=3nin the private sector. However, UHSM attends the poor population. The search is too much and many tings improper attention affects more and more the patient's health. The waiting time is long and it is necessary to invest more on public health care ,q~vices so that fast and efficient ,cervices can be provided. Lack of providing inunedlate services generate more expenses to the government. There are no incentives, and training to the employees. No regular courses on total quality control are being offered at the hospital and ff offered the concepts of total quality control are not applied in practice.
ACKNOWLEDGMENT The authors thank CNPq (Brazilian Research Council) for providing research fellowship to Prof. R. Radharamanan for the period 1995-96.
REFERENCES Akao, Y. (1990). Quality Function Deployment integrating Customer Requirements into Product Design. Productivity Press. ~xloy, L. P. and R. Radharamanan. (I 995). UtUizaftlo de Ferramentas de Qualidade Total no Servifos Prestados na ,~rea de SaYute. First International Congress of Industrial Engineering and XV National Congress of Production Engineering (ENF~EP), Universidade Federal de SIo Carlos, Sio Paulo, Vol. 1, p. 594-599. Shin& S. O. (1991). Concurrent Engineering and Design for Manufacture of Electronic Products, Von No.qra~ Reinhold, New York. Sloan, M. D. (1994). How to Lower Health Care Costs by Improving Health Care Quality. ASQC Quality Press, Milwaukee, Wi~onsin. -
Pergamon S0360-8352(96) 00171-4
0360-8352~96$15.03+ 0.00
QUALITY FUNCTION DEPLOYMENT AS APPLIED TO A HEALTH CARE SYSTEM
R. Radharamanan and Leoni P. Godoy Department of Industrial Engineering, Federal University of Santa Maria Santa Maria (RS), 97119-900, Brazil
ABSTRACT Quality Function Deployment (QFD) is used in a health care system to deploy the voices of the customers in understanding their requirements and to include them for continuous improvement of quality in s~'vices provided.
KEYWORDS Quality function deployment, quality in services, health care system, continuous improvement.
INTRODUCTION At present, health care industries throughout the world are struggling with the challenges of setting up economic ways and means of satisfying the human wants for health care services (Sioen, 1994). It is important to emphasize that Broil spends less in health care according to the standards followed in the developing countries, and the worst, spends bad as per the conclusions drawn by the world bank in its 1993 report on world development. The University Hospital in Santa Maria, (UHSM) has its justification for its existence with the community since it attends the health care requirements of the people. Here, one depends on the other for survival. The UHSM needs to have relations with the community, evaluate their requirements, and must lake into consideration their expectations to he prepared to attend them properly. The hospital guarantees its quality of service to satisfy or to exceed the expectations and requirements of its external (patients) and internal (employees) customers (Godoy and Radharamanan, 1995). The UHSM is one of the most complex reality enterprise and its principal objective is to attend the health care requirements of the community. In this paper, QFD ts used to deploy the voices of the customers and understand better their requirements to include them for continuous improvement of quality in ~ c e s provided by the UHSM.
QUALITY FUNCTION DEPLOYMENT FOR HEALTH CARE SYSTEM Figure 1 h the matrix prepared by combining the demanded quality deployment chart and the qualily element deployment chart. This shows the correlation of results between Ihe t~nanded items and the quality elements. Figure 2 shows the quality element deph~r_~nt chart, as a function of executed services identifying the hospital activity factors (Akao, 1990). In Figure 3 the importance of these patients demancL~ have been ranked ba~qxl on their experience and interaction with the current patient ba~. The rating scale is: 1 Very low importance; 2 Low importance; 3 Some importance; 4 Important; and 5 Very important to the patient. Service point can be characterized as follows with the ratings indicated: well attended 1.5; attended satisfactorily 1.2; and poorly attended 1.0 (Shin& 1991). Figure 4 shows the partial structure of house of quality translating the UHSM patients requisites into requisites for improving the 443
19th International Conference on Computers and Industrial Engineering
444
service provided. The patients requisites are the negative and positive critics through complaints. Identify the requisites and take to the relation matrix to find out one of the following relations - strong, mild, or weak - using the symbols given in Figure 4.
Demanded Items I st level
2nd level
3rd level
Quality Elements
l'ralned and Good attitude reception Kind attitude and easy access ~atisfted in serving to hospital ,'mployees the patients ~esponse time Immediate attention and effective service '.lean room Bed adapted to the needs, clean bed cloths etc. Environment Quiet room, pleasing and silent environment Information Information about meals, payment, and visiting time Meals Served at convenient times, warm, variety, and in sufficient quantity Employees Attentive, competent, calm, and fa~t Fig. 1 Quality Elements in the University Hospital in Santa Maria, UHSM
1st level
2nd level
3rd level
Degree of Hospital Service
Degree of )egree of service at service at he reception Lhepatients room
12 3 4
56789
iDegree of IDegree of Degree of service at is~'vice in attention in the informa- meals served employees tion desk
10 11 12
13 14 15
16 17 18
Degree of information after discharge
19 20 21
where: 1. Pleasing reception; 2. More waiting time in the queue; 3. Degree of information; 4. Degree of immediate attention; 5. Degree of cordiality and kindness; 6. Degree of general cleanliness in the room; 7. Degree of ventilation and illumination; 8. Degree of calmness and silence; 9. Degree of insects contamination (cockroaches, flies and mosquitoes); 10. Degree of communication with persons from the nurse ward; 11. Degree of promptness; 12. Degree of information about the treatment offered; 13. Degree of convenience of meals time; 14. Degree of meals quality, warm and variety; 15. Degree of meals quantity served; 16. Degree of attention and competence of hospital employees; 17. Degree of general services in the hospital; 18. Degree of patients value during hospitalization; 19. Degree of information about the treatment to be given at home; 20. Degree of waiting for consulting after discharge; 21. Degree of return to hospital. Fig. 2 Quality Elements Deployment for the UHSM Services
19th International Conference on Computers and Industrial Engineering
Pl~m~
ImporUmce ~AI 5
Quick
R~ponsc Clean Room Good Communication Quality
Hospital Now
Plan
Ratio of Improv~nt
445
Service Point
Absolute Weight
Demanded Weight
Io)
(E)
3
(P) 5
1,67
(c 1 ],2
10,02
15
5
2
5
2,50
1,0
12,50
19
4
3
4
1,33
1,2
6,38
10
4
3
4
1,33
1,5
7,98
12
5
3
5
1,67
1,2
10,02
!5
5
4
5
1,25
1,5
9,38
14
4
2
4
2
1,2
9,60
15
Total
65,88
M~Is
Proper Treatmeat Follow-up
D
=
A
x
B
x
C
;
P
B
N
;
D
E
~
100
x
Total
Fig. 3 Quality Characteristic Weight
Ouait~l ~,, Tagal¢ ~.~? '
~
~ -~
~
~ity
,\ ~
1st
Degr¢~of completoness
1¢v¢1
o f Hospital Scxvic¢
2rid
13~-g. of customer scrvie,e
level
provided by the Hospital
3rd level
\
= ~, ~ =~.~= ~=
___o ~,,
~
Meals - Service Quality =
-
-
Satisfaction
~ <
o
o '~
~-
\-o
Pleasing Reception P~! ~ Quick ~" ~ Response
15 19
o Clean
,o
= ~c,o o ~ c o ~
~2
~= "i U0a~ •-
/30 o/Q,!O/ /36/~/36
o/ //36
A,./ O / O,,,/ A , / O,,. / i/15 /'45 //45 ./15 /'45
15
Proper 14 Treatment 7ollow - up 15 lfier discharge Note:
O/ /45
O//
~.~ ~oom = ~cation ~ Quality
O,/
o/"
.
//42
/i2~ A/A
A/
Q/
/15
,/45
"..'
/15 /15
@ Strong relation (9) 0 Normal relation (3) A Weak relation (I)
Figure 4 Quality Chart (Partial)
446
19th International Conference on Computers and Industrial Engineering RESULTS AND DISCUSSIONS
The results have been analyzed as a function of: patients reception when they arrive at hospital, the room environment where they are hospitalized when treatment is needed with specialized professional assistance, the meals quality, and the assistance from the nurse ward. These four types of benefits that are obtained with the house of quality identify opportunities for future improvements and encourage programs for improving service quality in the health care systems. With regard to the understanding of the necessities of the patients, the results obtained show thai there exists really a lack of information, principally in admitting patients in the hospital. Other problem that appears is the lime spent by the patient in the "waiting room", before attended by the doctor. There are many critics made about the waiting time in the doctor's consulting room in the hospital. With regard to the room the complaints are about the p r ~ t c e of insects principally during the warm seasons. Other information obtained was aboul the meals, many times served cold, but quantity served is sufficient. There were no complaints about the nurses. They are always in contact with the patients and try to transmit the information clearly about the treatment.
CONCLUSIONS The functions of the hospital are sufficiently known and outspread. However, the functions are not always performed to the necessities which involve the eff'w~cy of the service. This happens because the economic structure of the country does not accompany the population growth. It is verified that the resources and the investments in the health care do not satisfy the necessities of the clients. To correspond to the increasing demand of quality, there exists necessity of constant modernization of the health care system In the public organizations, there exist certain opposing points in obtaining the service quality that are not coi-tiii-=3nin the private sector. However, UHSM attends the poor population. The search is too much and many tings improper attention affects more and more the patient's health. The waiting time is long and it is necessary to invest more on public health care ,q~vices so that fast and efficient ,cervices can be provided. Lack of providing inunedlate services generate more expenses to the government. There are no incentives, and training to the employees. No regular courses on total quality control are being offered at the hospital and ff offered the concepts of total quality control are not applied in practice.
ACKNOWLEDGMENT The authors thank CNPq (Brazilian Research Council) for providing research fellowship to Prof. R. Radharamanan for the period 1995-96.
REFERENCES Akao, Y. (1990). Quality Function Deployment integrating Customer Requirements into Product Design. Productivity Press. ~xloy, L. P. and R. Radharamanan. (I 995). UtUizaftlo de Ferramentas de Qualidade Total no Servifos Prestados na ,~rea de SaYute. First International Congress of Industrial Engineering and XV National Congress of Production Engineering (ENF~EP), Universidade Federal de SIo Carlos, Sio Paulo, Vol. 1, p. 594-599. Shin& S. O. (1991). Concurrent Engineering and Design for Manufacture of Electronic Products, Von No.qra~ Reinhold, New York. Sloan, M. D. (1994). How to Lower Health Care Costs by Improving Health Care Quality. ASQC Quality Press, Milwaukee, Wi~onsin. -