Quality through Design and Planning

THE IMPORTANCE OF DESIGN AND PLANNING

It is hard to think of the quality of a house or a car without at the same time considering the design and planning that goes into the production process. Yet in many organizations the approach to quality (often the only one) is that of correcting deficiencies. Problem solving and correction will no doubt contribute to quality improvement but quality has to be achieved first before it can be improved. It is also obvious that it is better to abandon a poorly designed project than to attempt to salvage it through improvement. The most important step in achieving quality is by starting with a proper design. Where certain policies and procedures are already in place and entrenched, redesign (more popularly termed re-engineering) may be necessary. Therefore design and planning are not confined to just new projects but is relevant to all current activities.
The components and activities associated with design are best understood by application of the Systems Theory of Operations Management. The “Systems Approach” as popularized by  management experts Koontz and Weihrich, and used to good effect by Donabedian, explains how outcome is dependent on raw material, equipment, personnel, the environment and processes. The framework of the ISO 9000 Quality system audit is also based on this approach.

Systems Theory of Operations ManagementSystems TheoryAn output or product results from the transformation of various inputs. Processes effect this transformation. The term product is not necessarily applied to goods only, but is applicable also to the result of any useful transformation of input that may include information and ideas. The term production is not synonymous with manufacturing only. The production of a play for example, requires material as well as non-material input and uses various technologies. The end product is a few hours of entertainment for viewers. Production systems are affected by the environment and at the same time impact on it. Both the physical and cultural environment has been repeatedly shown to affect quality and productivity.

Managing the way input, processes, the environment  are put together to produce an output is termed as Productions Management.

DESIGN STRATEGY

The strategies necessary in designing for quality include:

  • Setting standards of the output according to customer needs
  • Putting in place the optimal input, systems, processes and environment for producing quality outcome ( ‘quality is built in’, Standardization, Quality control, Quality through prevention.)
  • Minimizing the cost of quality (doing it right the first time every time)

These strategies and their objectives are discussed below:

MATCHING PRODUCT STANDARDS WITH CUSTOMER NEEDS

THE CUSTOMER

The term customer is usually applied to the person buying or using the product. However, people affected by the product are also customers. Many organizations such as government departments must consider the needs of whole communities rather than just the immediate customer. Even private organizations have obligations to society. Impact on the physical as well as the social environment must be considered in any design. Rules and regulations must be conformed to and cultural sensitivities must be respected. Too much emphasis on immediate gains may jeopardize long-term prospects.
Within organizations the product of one process is the input for the next process. Therefore the person responsible for the next process is the customer of the owner of the current process. The needs of ‘internal customers’ i.e. customers within organizations  also requires due consideration.

PRODUCT DESIGN

The quality features of a product are defined by customer needs and on the nature of the product. For most products, these desired features include characteristics such as functionality, ease of use, affordability, aesthetics, compatibility, durability and serviceability. For services, satisfying expressed needs alone may not be enough. How these needs are provided and the atmosphere in which the service is conducted is just as important. The features of services valued by customers include effectiveness, timeliness, accessibility, affordability, reliability, responsiveness, flexibility, safety and courtesy. In designing a product or service, these features need to be built into the relevant components of that product or aspects of that service. Intangible features such as aesthetics or responsiveness need to be converted into measurable and reproducible specifications.

In health care, the effects of the service on the customer/patient (effectiveness and safety) are most important.

STRIVING FOR THE BEST PRODUCT OR OUTCOME

Standards of products or outcome are set at the design stage. A standard is the acceptable level of the measure of a particular feature or characteristic. This level may be the highest achievable or an optimal range depending on capabilities of the organization and the expectation of clients (e.g. the market segment served). Standards of products of business companies are set to ensure competitiveness. Benchmarks are often used. Other organizations may want to conform to universally accepted standards defined by various professional or regulatory bodies. The upper limit of product standards is often constrained only by technology. As resources are usually finite, trying to produce the technologically most advanced product will affect features such as affordability or accessibility. Striking a balance is the challenge of good design.

PUTTING IN PLACE THE OPTIMAL PRODUCTION SYSTEM

DETERMINANTS OF QUALITY

Input, processes, the environment and the way these are put together and manipulated (the Production System) are the determinants of quality.

DETERMINING INPUT SPECIFICATIONS

Input includes physical structures, facilities, machines, tools, raw material, human resource, information and ideas. Both quantity and quality of the input will affect the quality of the final product or service. Defining input characteristics and choosing them are essential tasks of the design process.

Raw materials are chosen especially for their ability to impart certain desirable characteristics to the final product such as durability and aesthetics. Other considerations include availability, costs and compatibility with the technology used in the production system. In health care, safety is an essential feature of raw material such as drugs, fluids, sutures, implants etc.  The infrastructure must complement the technology used and the layout of the processes.

Human resource is probably the most important factor in determining whether quality standards are met. The knowledge, skills and attitude of workers need to be defined for specific tasks and these criteria are used when recruiting staff and for identifying their training needs. The value of data and information as an input cannot be overemphasized.

PROCESS DESIGN

The characteristics of processes are defined by the technology being used. Each process has the function of transforming the raw material or adding value to the product in the making. The processes used can be categorized into Technical processes, Communications, Cognitive processes, Data Management processes and Administrative processes.
A good design should define how processes are to be carried out, by whom, when, at what speed and the specifications of the output. The preparation of documented standardized policies, work procedures, instructions and output specifications (standard operating procedures) is an important activity at the design stage.

PRODUCTION/SERVICE DELIVERY SYSTEM DESIGN

The design of the production system describes the interplay between the inputs, the techniques used, the sequence or order of the processes and how they are laid out. The input, processes and the work environment should complement each other. Production systems should be efficient, reliable, sustainable, cost effective and compliant with legal requirements. For this reason it must be rigorously tested using the experimental approach of PDCA (discussed below).

The realization of a good production system is a very challenging task requiring the skills of a Production/Operations Manager (Director of Operations or Chief Executive Officer). Therefore quality management is part and parcel of Operations management.

ENSURING CONFORMANCE TO SPECIFICATIONS THROUGH THE QUALITY PLAN

Standardization is the process of defining uniform specifications and standards for the end products, input and processes. It is an essential step in enabling a system of ensuring conformance to be developed. This system consists of quality measurement and quality control procedures besides quality improvement activities (see below).
The activity of defining and documenting conformance (i.e. how the requirements for quality are to be met) is referred to as the Quality Plan (QS 9000 Definition).

In order to produce results that are consistent with specifications and standards, the workforce need to be aware of the product design and production system requirements. Therefore operational policies, standard operating procedures and work instructions must be made available for use (as a document called the Quality Plan) and training must be based on these.

OPTIMIZING QUALITY COSTS

An important goal of design is minimizing the final cost of the end product. Quality costs are the additional expenditure required to produce a product of a certain quality other than the production costs (cost for buildings, machinery, material, labour). Quality costs can be categorized as:

  • Prevention costs (cost of setting up the quality system, design, training)
  • Appraisal and Control costs (costs of measurement and control techniques)
  • Failure costs (waste, rework,  warranty, repairs, damage control, recovery of goodwill)

A good production/service delivery system design will improve productivity and efficiency. Better control will improve conformance and reduce costs incurred by discards, rework, repairs and post-delivery services. However measurement and control cost money. There is also a limit to the benefits of intensifying control. It is better to allocate extra effort and expenditure to the design activity. A good design should lead to predictable and consistent results requiring less control and fewer defects if at all.

IMPLEMENTING THE DESIGN: PLANNING FOR QUALITY

The designing process is not complete until the production or service delivery system is tested and the results compared to the desired output standards. The Deming PDCA Cycle is the most effective approach to use.

Application of the PDCA Cycle in the Implementation of a Design

PDCA 2

First of all the strategy, methods and schedule of implementation of the design are thought out and documented (the Plan stage). Simulations, trial runs or pilot projects are carried out and models or prototypes made (the Do stage). Various parameters of input, processes and output are measured (the Check stage). These are used to determine feasibility, productivity, efficiency, costs and most importantly conformance of the final product to specifications. Where shortcomings in the design are detected, changes or fine-tuning are done (the Amend stage). The production design may be changed to ensure that product conforms to desired specifications. However, it may be necessary to make minor changes to the product specifications to make production feasible. The cycle is repeated for every change made until a satisfactory design is adopted.
Designing for quality is an integral part of planning which in turn is a major function of the overall management of any organization. A good design would give clear guidelines to the operations manager on activities such as materials and machine procurement, staffing and human resource deployment, scheduling, storage and delivery.

ACHIEVING QUALITY THROUGH GOOD DESIGN

Designing presupposes that an entity is involved. In both manufacturing and service delivery, this entity is usually termed as the “Service Product”.

SERVICE DELIVERY AS A PRODUCT

Definition of a Product

The term “output” is a generic term commonly used to mean: the result of any transformation process, whether it is tangible or intangible. “Outcome” is often used when the result is intangible.
Traditionally a “product” is defined as the result of transformation of raw material into a new entity through manufacturing processes. However in modern usage the term ‘service product’ is used for service packages e.g. a banking product, an insurance product, a tourism product or an educational product. Services can be designated as service products by defining specifications and standards of various features of that service, thus enabling quantification, reproduction, costing and quality assessment.
An understanding of the systems theory of operations management as applied to service provision will clarify the meaning of services as products.

In manufacturing of products, the customer’s earliest contact with the product is when he or she is appraising, buying and using the product. Often the customer is unaware of, nor interested in the input and processes that go into the production process. In contrast the scenario is very different in service delivery. In most instances, from the very onset the client must enter into the internal environment of the provider in order to obtain service.

The ambiance formed by space, sounds, lighting and colour affects the customer and creates an initial and often lasting impression of the quality of the service.
Next he or she comes into contact and often interact with the input be it human, machines or technology used. Interaction and communication between clients and providers is almost always necessary when service is given. The characteristics of this interaction and communication are important quality features.
In many services such as health care or beauty saloons or transportation, the clients themselves are in contact with and interact with instruments and machines. Today, there is an increasing trend for machines to assume the role of receptionists, clerks or telephone-operators e.g. in electronic banking.
In service industries, the manner with which the desired outcome is achieved affects the client as much as the outcome itself. Process characteristics determine features such as efficiency, timeliness, responsiveness, flexibility and convenience. In many instances clients are involved in the service delivery processes. This involvement is often critical and necessitates two-way communication or positive feedback from the client before the next process can be executed effectively. Examples include filling forms accurately in case of clients of banks or taking medicine as prescribed in the case of hospital patients. (Even “waiting” can be considered as a process in many service procedures). Another effect of this involvement is the exposure of the client to unwanted effects.

Intermediate vs. Final Product

In both manufacturing and service sector operations, it is useful to differentiate intermediate products from final products. In manufacturing, parts or intermediate products are produced and then further transformed or assembled to make the final product. The distinction between intermediate products and the final product in service delivery is less clear. Is the product of a restaurant “relieving a patron’s hunger” or that of a hospital “curing the patient’s illness”?

Transformation Process

Transformation

The involvement of clients in processes and the effect of these processes on clients also mean that intermediate products of services are just as important as the final outcome. Intermediate products can be the substrate for the next process or it can stand on its own as a component of the service. For example in health care delivery, the customer is involved in many events and experiences many conditions and situations as he goes through various processes at various parts of the hospital. The way a process like blood-taking is done and the outcome of this process affects the client as much as the final relief of his illness. The client would not be too happy if his or her arm became swollen and discoloured after the venepuncture or worst still the process was successful only after repeated attempts, even if in the end he/she has his/her illness cured.

The Customer (Patient) Journey or Experience

Customer Journey

QUALITY FEATURES OF SERVICES

Satisfying the primary needs of the client is undoubtedly the most important final outcome of a service. The attributes of this outcome are the most important features of any service. However, it is apparent that besides these, the totality of the quality features of a service is formed by characteristics of the environment, facilities, machines, staff attitude, staff behaviour and indeed the whole organizational culture.
These features serve the secondary needs of the client (but nonetheless equally important). Indeed in a competitive environment these features add value to products and provide the competitive advantage.

OUTCOME CHARACTERISTICS

The characteristics of the physical infrastructure, staff-client interaction and service delivery methods are important features of services. The management of these aspects must be given as much attention as providing the primary needs of the client.

Characteristics of Final and Intermediate OutcomeCharacteristicsTherefore designing services requires an integrated approach where features of input, environment, processes and systems are given due consideration without losing sight of the main objective i.e. the final outcome.

GENERAL PRINCIPLES OF DESIGN OF SERVICES

A design is a detailed picture or description of the intended form and function of a product. The activity of ‘designing’ refers to the process of describing how a product will look like and function. This is done by first determining the specifications and then formulating or building a model. The main aim of product design is to match form and function of the product with the requirements or needs of customers. In other words the product features are built into the design.
Planning, on the other hand, means setting goals and establishing ways of achieving these goals. Planning refers to how to make the design a reality.

PURPOSE OF PRODUCT DESIGN

As stated above, the major aim of product design would be to satisfy customer needs. However there are other considerations.
The basic requirements of a good product design includes:

  • Reproducible: has clearly defined repeatable specifications (of input, process and environment)
  • Parts or components fit well to make a whole
  • Feasible: can actually be produced (i.e. resources and technology are available or can be made available, at a reasonable cost, to produce the product as designed)
  • Functional: once produced, will actually do what it is supposed to do

OPTIMIZATION OF DESIGN

Efforts must be made to provide the best possible product or service taking into account various constraints. Consideration is given to:

  • Balancing needs of customers with costs, complexity and time available (making the service compatible with the the individual needs of the client as far as possible)
  • Making it usable by the client in the most convenient and pleasant manner (user friendliness),
  • Adopting methods that is safe, convenient and easy to use by workers
  • Putting in an environment that is safe and conducive for clients and workers

Service excellence is difficult to define and probably hard to achieve in healthcare. Constraints of costs leads to scarce resources which in turn leads to curtailing the amount of time spent on a client. It also means that often waiting is inevitable. Generic packages and plans are easier and less costly to deliver. Yet it is desirable to offer customized individual services when necessary. This may not be necessarily a very substantial departure from the usual service but attention to small details do make a difference not just on the outcome but also on the overall experience of the client.

Often healthcare institutions have existing facilities where the physical environment are optimal to start with. However efforts need to be made to improve the physical layout so as to make the process flow more convenient. Above all, the physical structure and the physical environment should be safe for the clients and workers alike. When choosing furniture, equipment and machines, preference is given to those that are easy to use by clients and workers.

APPROACHES TO DESIGN

Depending on requirements and opportunities, a good design can be achieved through one or a mix of two approaches:

  1. Developing an original design
  2. Modification or adaptation of an existing design

For a new product, to create an original design consists of bringing concepts to reality. On the other hand, an existing design that is already good can be replicated with modifications to suit particular needs  and limitations.

DEVELOPING ORIGINAL DESIGN

When developing a new product, the designing process follows a series of steps i.e.:

  1. Identify the customer(s)
  2. Establish customer needs
  3. Convert customer needs into definite requirements & specifications
  4. define product features
  5. Choose methodology / technology, materials
  6. Conduct a feasibility study
  7. Plan
  8. Organize
  9. Produce prototype (PDCA)
  10. Trials
  11. Feedback to redesign

These steps are depicted in the flowchart below.

Production System DesignProduction Design

Modifications of Existing Design

Most discussions on design almost always assume that products are designed from scratch. In reality most products are modifications and adaptations of previous products or similar products being produced elsewhere. In manufacturing originality is much valued and used as a marketing strategy. However, whether one is designing an original design or modifications of existing design or benchmarking, the basic principles of and approach to designing need to be adhered to.

Designing Services and Service Delivery Systems – Basic Principles

Services are delivered to serve customer needs. To design a service product that fulfills the needs of customers the following questions need to be answered by members of the organization:
• What business are we in?
• Who are our customers?
• What service products are we producing?
• What is the function of the product i.e. what customer needs are to be met?
• How do we go about satisfying these needs?

Benchmarking

Whether it is for designing a new product or improving on an existing one, emulating others who have done well is very beneficial. The process of studying the service delivery systems of reputable organizations and trying to achieve their level of outcome is called Benchmarking. The aim is to discover best practices, understand how they are achieved and to try to adopt them in one’s own facility. It may not be necessary to replicate the whole service delivery system. Sometimes, it is only the adoption of certain policies or the way certain processes are carried out. Yet as policies and processes go, the ancillary factors that enable them to be more effective, efficient or safe need to be identified and put in place as well. It is not good to try to change processes without providing the necessary support (in terms of skills and tools) to the workers performing them.

The term benchmark is also used to mean the desired standard to be achieved where the standard is defined as the level achieved by the best among the institutions providing similar services. For example if an institution applies an alternative approach or method, it has to determine whether it is able to obtain the same or better results compared to that achieved by others.

Before embarking on benchmarking,  it is important that the organization or institution evaluate its own system and processes so as to know where the strengths and weaknesses lie (through SWOT Analysis). These are then compared with those present at the organization being benchmarked against. Indeed, most measures to be emulated need to be adapted to the prevailing circumstances within one’s own  organization. Benchmarking can be a one-off event or a continuous activity. It requires a good deal of effort and considerable investment.

Healthcare institutions and professionals like to share their knowledge and experience. As such it is not hard to visit other institutions and have in depth discussions with their management and personnel. One need to be sensitive to and be aware of good practices happening elsewhere. Indeed a department or unit  can emulate certain practices in another within the same organization, even if they are engaged in the delivery of different services.

Business Process Re-engineering

An institution  can improve its service delivery in two ways:

  • Small incremental improvements (Kaizen)
  • Fundamental alteration/revision of systems and processes in order achieve dramatic improvement (Business Process Engineering). 

Quality improvement through small changes and problem solving is discussed in another article. These approaches are not aimed at altering the basic design of the service product.

To achieve a large leap in productivity, efficiency and quality, the approach of Business Process Re-engineering (BPR) ought to be attempted. The opportunity  for radically changing service delivery occurs when a new technology is available. With it, comes the ability to make processes more efficient, easier to perform, more user friendly and safe.  With BPR, the entire or at least a major part of service delivery operations need to be re-designed or revamped. New Standard operating procedures need to be developed and documented. Staff need to be re-trained. Often the physical infrastructure and the work environment need to be upgraded.

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