Research Topics: Quality Improvement

QUALITY IMPROVEMENT – SERVICE DELIVERY

SERVICE DELIVERY AND QUALITY IMPROVEMENT   Introduction             One of the most important things to consider in being competitive in the marketplace is having quality service or product delivery. It is noted that having a systematic product and service delivery enables an organization to achieve customer satisfaction.  Further, ensuring quality products and services may help the company to be recognized in this arena. The main goal of this paper is to discuss in details the delivery of services offered in package delivery industry. In addition, this will also discuss the efficiency and effectiveness of the activities which make up the process. It will also provide some recommendations in order to improve the quality of the service and product to be delivered.   The Concept of Quality Improvement             The concept of quality with respect to customer satisfaction has been with us since the beginning. However; the formal study of quality is relatively new, dating back to early part of the twentieth century. Over the years, we have seen a variety of definitions for quality. These definitions have ranged in length from a few words to comprehensive discussions. Here are some definitions proposed for “quality” by authorities.       Quality is a physical or nonphysical characteristic that constitutes the basic nature of a thing or is one of its distinguishing features, Webster’s New World Dictionary. Quality, as applied to the products turned out by industry, means the characteristic or group or combination of characteristics which distinguishes one article from another, or goods of one manufacturer from those of his competitors, or one grade for product from a certain factory from another grade turned out by the same factory (1992).  There are two common aspects of quality; one of these has to do with the consideration of the quality of a thing as an objective reality independent of the existence of man. The other has to do with what people think, feel, or sense as a result of the objective reality; this subjective side of quality is closely linked to value  (1980). Hence, the challenge for the service sector is to develop ways of addressing the ‘quality problem’ which are appropriate to the needs of a sector whose principal asset is people and where the application of the skills and knowledge of those people it employs is the key differentiator between ‘good’ and ‘bad’ service.  Quality has become a central issue in the business community. Most companies of any size now have quality improvement processes. Quality improvement means doing things in order to enhance the way the product or service of an industry meets or exceeds the expectation of their target audience. Quality improvement is a systematic approach to the analysis of performance and systematic approaches to improve it. QI which basically aims in improvement measures where the operations are and identifying ways to make things better. Specifically, it attempts to avoid attributing blame and tries to create systems to prevent possible errors from occurring. Quality Improvement Methods includes qualitative and quantitative techniques, reduction of waste, benchmarking, training, customer focus and empowerment. FedEx Corporation was established by  in 1973 as an entirely new concept in package delivery an overnight air delivery service. FedEx was the pioneer of the express transportation and logistics industry.  In addition, FedEx is also regarded as one of the world’s leading transportation companies that focus on the transportation of parcels and packages worldwide. The following are the core, supplementary and facilitating services provided by FedEx: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Overnight package delivery </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Worldwide express delivery</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Ground small parcel delivery</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Freight delivery, and </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Customs brokerage.</li> </ul>   These services are being offered in a quality manner to satisfy their customers. Because FedEx has been able to expand their services internationally, the industry also provides different products and services to their customers in the international market like in Asia-Pacific. The products and services provided by FedEx in Australia and New Zealand include FedEx International Priority (IP), International Priority Freight Services and FedEx Packaging.   ·         FedEx International Priority (IP) The FedEx International Priority Service offers a time-definite, door-to-door technology-intensive, customers-cleared delivery of packages, documents and freight all over the world. This offering includes the FedEx International Mail Service which is available for bulk mailings of printed material like direct mail, invoices and catalogues. The clients of FedEx has the opportunity to choose from different delivery options which include door-to-door delivery using FedEx courier, customs clearance, holding for collection at a FedEx location and delivery through a broker or customer’s agent.   ·         International Priority Freight Service (IPFS) The industry is currently operating in five scheduled air services from the United Stated to Sydney every week. The majority of the traffic on these flights is IXP, to ensure a time-definite airport to airport service.   ·         FedEx Packaging In this service, the company used sound packaging system to ensure the fast and secured delivery of the shipment of the customers. In this regard, the company are able to develop their own range of ready-to-usee, self-sealing packaging in different shapes and sizes. At the hub, the range of boxes, tubes, envelopes and packs have been created to deliver superior durability and protection at the lowest possible weight. Service Delivery System of FedEx                         FedEx was the pioneer of the express transportation and logistics industry.  In addition, FedEx is also regarded as one of the world’s leading transportation companies that focus on the transportation of parcels and packages worldwide. In accordance to the activity around us especially when it comes to the speed and efficiency needed to serve the clients better, FedEx also has improved its performance when it comes to service through continuous changes in its IS and addition of certain programs like tracking lost parcels within thirty minutes which is of good help to clients and the such. This is very important so as to keep the company consistent of being number one on its spot. In this way, it will never fail to attract more clients. FedEx is committed with their People-Service-Profit philosophy. Herein, the company aims to produce outstanding financial returns by means of providing, competitively superior, totally reliable global air-ground transportation of high priority goods and documents that require rapid, time-certain delivery.  The company also aims to provide positive control of each package that will be delivered by using real time electronic tracking and tracing systems.  In this manner, a complete record of each shipment and delivery is being presented with the company’s request for payment.  The company’s goal is to become helpful, courteous and professional to each other and the public.  The vision of the company is to strive efficiently to have a completely satisfied customer every time they avail the services of FedEx. In order to provide quality service, the company has been able to implement different activities.  One of this is their adherence to e-business as one of the effective solutions to address the concept of quality.  FedEx employs a variety of Internet-based systems that serve both their needs and the needs of their customers. EC-Inventory, for example, enables different product classifications in selected locations to be tracked and managed and, thereby, can be used to validate orders against inventory levels and to track and trace orders and shipments. EC-Manufacturing provides FedEx customers with a powerful means of monitoring and controlling their inbound supply chain. EC-Return Management provides a useful means for handling returns and repairs, and EC-Warehouse Management provides FedEx customers with tools to improve their inventory and warehouse management. In these ways FedEx extends and adds value to the services they provide for their customers.       The FedEx service begins when a customer calls the nation-wide toll-free customer service number. This can be accessed 24 hours every day of the week. Once the customers requirements have been ascertained by a customer service operator/agent, an instant quote is calculated and, if accepted, a courier is then dispatched to the customers location to pick up the shipment and to provide documentation and packaging (where required) needed for international shipping. Customers are shown how to fill out an air waybill with all the correct information (including, for example, contact information about the sender and consignee, handling and delivery instructions, shipping information, duties and taxes), and are provided with a wide range of free packaging of different shapes and sizes. Central to the company’s growth and success has been the development of strategic information systems that enable FedEx to provide superior service to its customers. Through its innovative use of technology the company has been able to offer its customers the ability to complete entire shipping transactions from their own desktop personal computers, to call for courier pickups via modem and to track the status of their shipment en route. Almost all of Fed Ex’s total volume internationally is processed using an automated shipping system. In this manner, the company has been able to use advanced technology to ensure that they still meet the needs of their customers of fast and quality delivery system. The company has utilised different technology like FedEx’s Automated Sorting Tracking Routing Aid (ASTRA), Digitally Assisted Dispatch System (DADS) and COSMOS.   Cause and Effect Diagram             The activities mentioned above, states the service delivery system of FedEx. Although, it can be said that the industry has been able to use an effective and efficient service delivery system, there are still factors to be considered to sustain its efficiency, there is a need for quality improvement to ensure that the company will always adhere on providing quality service among its customers.  To improve the quality of the service of FedEx, the management should be able to identify different aspects that affect quality service of package delivery.   Cause and Effect Diagram             The diagram below shows the possible cause of having a delay in package delivery of the company. Herein, the causes are categorized as equipment, personnel, materials, procedures and other aspects which may affect the quality service of the company. Cause and Effect Diagram is used to determine the reasons for poor quality service. In addition, cause and effect diagram can easily show the problems and issues to be addressed to ensure that the company will always provide quality services in terms of package delivery.   Diagram 1: Cause and Effect Diagram Recommendation; Quality Improvement       Although, it can be said that the industry has been able to use an effective and efficient service delivery system, there are still factors to be considered to sustain its efficiency, there is a need for quality improvement to ensure that the company will always adhere on providing quality service among its customers.  As shown in the cause and effect diagram, one of the cause f ineffective delivery of packages is in terms of lack of employee empowerment. To improve the quality of the service of FedEx, it is recommended that the company will use empowerment method for quality improvement. For employees to be empowered, the company must provide means for employees to participate both at the shop or office floor and at higher levels in the organization.  In the service industry such as the shipping business, employee empowerment has been associated with many of the key issues related to employment practices in general, namely in gaining competitive advantage through improved service quality. However, the attempt to gain competitive advantage is difficult – because of the difficulties in defining the successful service encounter, particularly in the intangible sources of customer satisfaction. Moreover, there are in fact, some base level customer expectations of employee performance, positive interpersonal contacts, service deliverer attitudes, courtesy and helpfulness that are all closely related to customer evaluations of service quality (1994). Then another problem is in the quality of the service encounter itself. This involves the performance of the employee, on how the employee work and perform the service that should be given to the customers. (1993) stated that seeming to love the job becomes part of the job; and managing the appropriate feelings of enjoyment of the customer helps the worker in this effort. Enabling employees to sense their own power and the significance of their role in the service drama may help employees manage the emotions required of their performance ( 1993). Thus, it can be said that a respond or action of an employee enhanced by satisfaction can be the basis that the employee will give his or her best to the company. Empowered employees willingly take responsibility for the service encounter, they respond more quickly to customer needs, complaints and changes in customer tastes ( 1991). People are the cornerstone of the FedEx organization and service. Their importance and value is clearly recognized in the words of : Federal Express, from its inception, should put people first both because it is right to do so, and because it is good business as well. All Federal Express managers are expected to scrupulously follow as well as communicate to their people the successful formula inherent in our P-S-P philosophy: Take care of our people; they, in turn, will deliver the impeccable service demanded by our customers, who will reward us with the profitability necessary to secure our future.  Among the many means by which FedEx executes its ‘people first’ philosophy are the following initiatives: Ø      A staffing effectiveness policy which ensures responsible hiring decisions to enable the company to avoid layoffs wherever possible. Ø      Total commitment to affirmative action and equal opportunity principles. Ø      Performance review systems that provide feedback to employees on how they are performing against mutually agreed expectations. Ø      Promotion from within, which gives existing employees the first option on new and additional career opportunities within the organisation. Ø      The open-door policy which encourages employees to direct any question to the appropriate person regardless of their title. Ø      The guaranteed fair treatment procedure by which an employee can appeal any management decision, leading to a review process involving both other managers and the employee’s peers. Ø      Reward and recognition programs that encourage and honour exemplary service performance. Another vital component of P-S-P is the Survey-Feedback-Action (S-F-A) process. Once a year, the company must anonymously surveys all active employees about a range of issues including corporate and local management, work group cooperation, reward systems and job conditions. After company-wide tabulation, the results should be discussed at the workgroup level where solutions are developed to problems identified by the survey. Finally, each manager commits to an action plan to implement the agreed solutions. The initial training of new customer service personnel, sales representatives and couriers takes several weeks and culminates in written and oral examinations. Successful recruits should be placed on three months’ probation before a permanent appointment is made. The training and development of service personnel, however, must be ongoing, in order to ensure that Fed Ex, through its people, remains synonymous with exemplary customer service.   ACTION PLANS             To be able to implement quality improvement approach to FedEx, the company must be able to follow the following Action Plan.             I.  Introduction                         A. Research.             First and foremost the company must know the current situation of the industry. Using quality improvement tools like cause and effect diagram, the problems that hinder quality service can be detected. Hence, it is important that the company must be able to establish an internal marketing research to determine the factors to be changed and how quality improvement would be implemented. B.     Information Dissemination             The management of the company must be able to disseminate the information that the company will imposed some changes to improve the quality of the services offered by the company so that the employees will be aware in the situation.   II.   Specific Processes to Successfully Implement the Plan After the planning phase is over (and agreed), it is a signal of the doing phase begins. Once the activity is in motion, it acquires a direction and momentum which is totally independent of anything that was predicted. The key elements to the control of the changes are the milestones and established means of communication. The milestones are a mechanism to monitor progress; for the team, they are short-term goals which are far more tangible than the distant completion of the entire project. This maintains the momentum and encourages effort for the team; it allows the team to judge their progress and to celebrate achievement throughout the activity rather than just at its end.   III. Dangers in review There are dangers avoiding this project reviews, it is either too frequent or too drastic . The lack of sustainability to the project can lead to plan revisions which shake the team’s confidence in any particular version destroying the stability of the project designed. Decide objectively, and explain beforehand, when the review phases will occur and make this a scheduled milestone in itself. Even though the situation may have changed since the last review, it is important to recognize the work which has been accomplished during the provisional. First, the organization do not want to abandon the project since the team will be demotivated feeling that they have achieved nothing. Secondly, this work itself is part of the new situation which has been done, it should provide a foundation for the next step or at least the basis of a lesson well learnt. Existing achievements of team should always be building up.                         V.  Time             Time is sometimes one of the problems since there are companies that are demanding for unrealistic time. For this project, realistic schedule viewed by the team should be imposed.  Outside world are not allowed to deflect team form what knows to be practical. If the impose a deadline upon which is impossible, the team will clearly state this and give reasons.  For this instance, the project teams must determine the most appropriate time to start the implementation of the project; the sooner, the better.               VI.   Planning for error One of the most common errors in planning is that assuming there will be no errors in the implementation which in effect, the schedule is not based on the plan. On the other hand, recognizing that errors will occur is the reason for implementing a monitoring strategy on the project. However, by cautiously considering errors in advance you can make changes to the original plan to enhance its tolerance. The team that would implement quality project must try to predict where the errors will occur by examining the activities’ list. The risky areas might then be given a less strict time-scale – actually planning-in time for the mistakes. Another option is to apply a different strategy, or more resources, to such activities to minimize the disorder in the project.   Conclusion             Although FedEx has been efficient in providing satisfying services for their customers, the company must be able to ensure that they always adhere in providing quality for its customers. In doing so, the company must implement quality improvement process. Herein, the company must choose specific issue to be given emphasis and improve the system attached within such issue.   Reference             Credit:ivythesis.typepad.com

QUALITY IMPROVEMENT – SERVICE DELIVERY

SERVICE DELIVERY AND QUALITY IMPROVEMENT Introduction One of the most important things to consider in being competitive i...

Quality Improvement – Occupational

Quality Improvement – Occupational   Introduction   Quality Improvement             According to  (1992), systemic quality improvement processes (QIPs) must include five overlapping phases.  They are the familiarization, vehicle emplacement, training, implementation of measurement techniques, and long-range or strategic planning.  During the familiarization phase, which should always comes first, upper-level management, quality department staff members, and consultants explain to the entire work force the need for improved quality.  They usually begin this process at the top of the organization, working their way down gradually to the hourly ranks.  They help employees realize that a successful quality improvement process is just that.  Rather than a project or an exercise with an end, it is an ongoing process that eventually causes the corporate culture to change, to become more participative and better integrated. They explain the difference between quality control, which basically checks for product defects and then tries to discover and eliminate the causes of these defects, and the new, more comprehensive quality thrust that realizes that better product quality results from improvements in the quality of manufacturing processes, management systems, and the work environment as well.  They stress that the ultimate objective of QIPs must be to improve the bottom line, that if the corporation fails financially, the rest is meaningless. In abridgment, the familiarization phase is self-defining. Its purpose is to offer the “why?” behind a QIP and the “what do we need to put into place to accomplish our objectives?” It is ongoing. Presentations are made continually, at all employee levels, with shifting emphasis depending on the audience and the process stage. Tools used during the familiarization phase can include posters, videos, presentations, stickers, visits to other sites–anything that will help employees: focus on improved quality as a primary workplace objective; better comprehend the power being given them; and better understand the corporation’s customized approach. Vehicle Emplacement Once the familiarization phase is well under way, most corporation jump directly to training rather than to team building.  Team building is very important since most quality consultants and members of QIP departments lie primarily in training, in working directly with individuals’ problems and group processes which is the major reason why they fail so quickly during the training.  There is a critical difference between the familiarization phase and the training phase.  The former can be presented to large audiences and completed in several weeks, while the latter, when dealing with a company of any size, ultimately involves running several thousand students through well-organized two- to three-day sessions.  Such an effort is extremely drawn out so that by the time that everyone is trained, many of the earlier students have lost their enthusiasm, their workshop notebooks, or both.  At the same time, such training is rarely if ever adequate. Learning a technique in the classroom, even practicing it there, never gives students all the answers or prepares them fully for the real-life situation. A tremendous amount of support, therefore, is necessary when those initially trained begin passing down their new knowledge and skills to lower-level managers and hourly workers. Such support, however, is rarely available. The corporate quality staff and consultants can visit just so many work sites during the year and can answer just so many phone calls. However, many middle managers see QIPs as an attempt to get rid of their jobs.  They’ve heard about too many layers of management and about the push to get hourly workers to make more work-related decisions so that some of these layers can be eliminated.  Giving middle-level managers the responsibility of passing on problem-solving and decision-making skills is, in many cases, like asking the last werewolf to teach the pretty lady how to shoot silver bullets. It doesn’t make sense. Inexperienced or emotional supervisors create a fuss or refuse openly to cooperate. The old-timers go through the motions but then make sure that nothing happens. The Training Phase The training phase starts soon after the first teams are in place and follows the team building phase through the organization. It “follows” because initial facilitator training is done on the job and because team members identify a large number of their own training needs. Implementation of Measurement Techniques The trick, however, is to give the teams ownership, to let them decide that what is being offered is a good idea and should be spread throughout the operation. The basic techniques involved–histograms, run charts, control charts, flow charts, pareto, the fishbone, and scatter charts–are not that difficult to teach or to use. The hard part traditionally has been to get employees to want to use them. There are three possible approaches. The first is coercion: learn how to use these or start looking for another job. However, when employees are forced to implement something they don’t understand the need for, they tend to make a lot of mistakes. The second approach is to educate workers to the value of measurement techniques. Conscientious and ambitious employees will listen and will make a sincere effort to implement what they have learned. Those just putting in their hours, however, will see the additional time and effort requirement as another unwelcome imposition and will take shortcuts.   The third approach is to encourage the employees themselves to discover the value of the techniques. This is obviously superior, but how do we achieve it? We do so primarily by developing a strong sense of employee commitment to improved quality in products, manufacturing processes, management systems, and the work environment. But how do we engender this required commitment? The answer is that we foster it through the familiarization, vehicle emplacement, and training phases that precede the introduction of measurement techniques. Strategic Planning In order for QIP organizers, familiarizers, team facilitators, trainers, and team members to succeed, they must have a framework built on clearly defined organization objectives into which to fit their integrated efforts. This framework, or overview, traditionally has been created through the annual strategic planning exercise. Recently, however, strategic planning has fallen on hard times. It is no longer considered a critical function in many corporations. The future of such organizations is now being decided by the president or CEO and a few confidantes, their decisions based on a mix of financial considerations, their own observations, and gut instinct. The reason for the recent disenchantment with strategic planning is twofold. First, our much maligned short-term orientation makes the ability to react quickly to shifting environmental circumstances more important than the ability to gen1erate a long-term plan. Second, even if our orienta- tion were long term, strategic planning, as it has been practiced during the seventies and eighties, does not work. Strategic planning is important, not only to quality improvement but to the long-term health of any organization. Asian and European firms do it effectively and have used the results to increase their share of world markets. The problem, therefore, is not that strategic planning does not work but that the paradigms that we have been using in the United States are not right for our situation. In order to be more successful, we need an approach that helps replace or combine our short-term orientation with a long-term one; discourages in-house competition for resources; helps generate consensus on priorities; encourages the necessary integration; effectively reads and reacts to the organization’s increasingly turbulent environment; and does not impose unrealistic demands on those required to translate corporate objectives, as defined, into reality. Interactive planning, like comprehensive quality improvement efforts, has five overlapping stages.  These are formulation of the mess; ends planning; means planning; resource planning; and implementation and control. Formulation of the Mess –A “mess” is defined as a system of problems.  During this stage the future of an organization is charted if no changes are made and if the environment remains stable. Ends Planning –During this stage participants define an “ideal.” They are told that their company, mill, or department has been destroyed and that they are responsible for totally rebuilding it. The charge, however, is to design what ought to be ideally, rather than simply to improve on what originally existed. The only three stipulations to this exercise are that the systems designed must be technologically feasible, financially reasonable, and capable of adapting to future environmental change. Means Planning –During this stage projects that will help move the organization from its current “mess” toward the ideal are defined and prioritized. The QIP teams can play a key role in both definition and prioritization once overall organization objectives have been identified. Resource Planning –The teams can contribute heavily to both the identification of available resources and allocation decisions. Implementation and Control –The teams can assist in carrying out action steps.  They can also generate the information necessary for proper control and function as a channel for the upward and downward flow of this information. ALL OR NOTHING All systemic and successful QIPs must include the five phases discussed above. None of these phases can provide the desired results without the support of the others. Familiarization is of little value without a change vehicle, training, and a framework of long-range organization objectives. Teams cannot function effectively without proper familiarization, relevant training, and long-range objectives. Training is largely a waste of time without a change vehicle and a framework of objectives.  Measurement tools are all but useless by themselves. Finally, a strategic plan has no value unless employees understand it, are committed to it, and possess the knowledge and skills necessary to implement it. While all five phases are important, vehicle emplacement, or team building, is the most critical. Team building is also the most difficult phase to introduce. A majority of team building efforts in the United States have failed. They have done so mainly because those responsible have not understood the systemic nature of the beast that they were trying to tame and have left out critical pieces, or have been unable to link the pieces together properly. Pre-Employment Screening Hiring the right people is more important than ever before. In fact, hiring the right people with the right skills can make a difference to your organization and ultimately to your company’s financial success. The cost of making poor hiring decisions is evidenced in high turnover, discontented employees and reduced productivity. These operational pit falls have devastating impact on the ability to grow your business and create a work environment that is stimulating, efficient and effective. Why is there a Need for a Quality Improvement on Pre-employment Screening?             Apart from issues of social justice, ethical behavior makes good business sense. Unethical behavior is expensive. Discriminatory practices, negligent hiring, and product quality failure can incur large legal judgments. In the United States, employee malfeasance costs companies billion to billion per year. The value of white collar deviance alone is one thousand percent of the annual loss incurred by all street crimes and burglaries. Thirty percent of American bankruptcies are substantially attributable to workers who willfully disregard company norms and social law (1993; 1991, 1991;  1987: 1985;1993;1988).  These are such a good reason for the importance of quality improvement on pre-employment screening.  Many companies use pre-employment integrity tests to detect job applicants who are likely to violate standards of appropriate behavior.  These tests are controversial.  Although critics claim that research and ethical practice cannot support the use of these measures for employee selection, supporters have reached the opposite conclusion (1993; 1994; 1991; 1991; 1991;1994;  1987; 1990). Support for integrity testing is based on three conclusions. First, a growing consensus holds that pre-employment integrity tests predict important job-related criteria regardless of job type or setting. It is reasoned the tests tap broad personality constructs, such as “work conscientiousness,” which influences a wide range of job attitudes and behaviors. Second, the tests lack adverse impact against females or members of racial and ethnic minorities. Third, applicants generally regard the tests as appropriate for job screening ( 1993;  1993;  1989;  1984). Pre-Employment Background Check Why should you screen your employees with an employee background check? <ul type="disc" style="margin-bottom: 0in"> <li class="MsoNormal" style="color: black; text-align: justify; text-justify: inter-ideograph; line-height: 200%; margin-bottom: 12.0pt"> 67% of criminals released from prison in 1994 were re-arrested for at least one serious crime within the next three years (Bureau of Justice Statistics, 6/2/02)</li> <li class="MsoNormal" style="color: black; text-align: justify; text-justify: inter-ideograph; line-height: 200%; margin-bottom: 12.0pt"> The National Crime Victimization Survey, released by the  Department of Justice in December of 2001, analyzed workplace violence from 1993 to 1999. On average, 1.7 million violent incidents per year were committed against employees at work.</li> <li class="MsoNormal" style="color: black; text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Nearly 60% of sex offenders are under conditional supervision (probation or parole) in the United States. (Bureau of Justice Statistics) </li> </ul> Small and mid-sized businesses are particularly vulnerable without an employee background check… Small businesses are the most susceptible to employee fraud, according to the Association of Certified Fraud Examiners. In a small company, a single employee tends to have a large amount of responsibility and a small amount of managerial oversight. Obtaining access to sensitive information or the company’s finances is not very difficult for employees within smaller businesses. Businesses with less than 100 people are more likely to incur fraud losses than companies with more than 10,000 employees. According to the 2002 Report to the Nation on Occupational Fraud, the average loss for a small business is 7,500 and the average loss for a large company is ,000. Victims recover less than 25% of their losses in about half of all cases filed (). Pre-Employment Drug Test Why perform a pre-employment drug test? Substance abuse testing can decrease workplace accidents, cut production costs, save wasted salary dollars, cut increased medical costs, decrease workers’ compensation premiums, lower employee turnover, reduce theft and shrinkage, and increase morale and loyalty. Consider these facts: <ul type="disc" style="margin-bottom: 0in"> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Employees who abuse drugs are about 30-35% less productive than non-users.</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Employees who abuse drugs and alcohol cause more than 40% of on-the-job injuries.</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Employees who abuse drugs are more likely to steal to support their habit.</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Employed drug abusers cost their employers about twice as much in medical and worker compensation claims as their drug-free coworkers. ( 1999)</li> </ul> ScreenNow Employment () offers several assessment tools designed to improve your ability to select the right candidate and ultimately impact your employee retention, employee satisfaction and overall operating success.  It is committed to creating a safer and more secure workplace through the responsible use of information.   ScreenNow Skill Assessment tests will help you: <ul type="disc" style="margin-bottom: 0in"> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Measure a candidate’s job expertise and confirm pre-existing knowledge </li> <li class="MsoNormal" style="color: #000033; text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Reduce employee turnover due to misrepresented qualifications </li> <li class="MsoNormal" style="color: #000033; text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Accurately quantify the skills of job candidates </li> <li class="MsoNormal" style="color: #000033; text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Motivate your existing staff to develop new skills </li> <li class="MsoNormal" style="color: #000033; text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Increase productivity, morale and commitment </li> </ul> ScreenNow Employment online is widely used in the United States by different industrial sectors and has already received positive feedbacks from its clients.  It is very useful in the screening process of these industries and became a great part of their development since they are guided into the best projected employee that they are looking for.  Conclusion             Quality improvement is every company’s practice in the hope of uplifting its standard for the growth and development of the employer, employee, product and services.  However, without proper knowledge in doing so, quality improvement process may seem worthless and instead, a costly practice.  It would take an extensive effort in the part of the company in achieving the desired quality improvement.  Resourcefulness and creativity will then be the key for this.              Having an inventive energy and the determination to reach such goal is not that tough nowadays.  With the advent of information technology that brings us closer to whatever queries we got in a hassle-free manner, this objective is not beyond our reach.  Pre-employment Screening             A company can then apparently recognize the link that binds quality improvement and pre-employment screening through research method.  This is very evident in the previous findings on the need and importance of development in the pre-employment screening. Not only is this paper could help in the improvement in the screening area but this study will also help upgrade the industrial sector as a whole.  In no longer time, the economic lifestyle of a company will then be change for good towards its goals and objectives.                          Credit:ivythesis.typepad.com

Quality Improvement – Occupational

Quality Improvement – Occupational Introduction Quality Improvement According to (1992), systemic quality improvement pr...

Improving the quality of a working environment

Improving the quality of a working environment               “There is no place like home,” as what had Dorothy had said in the Wizard of Oz; truly, no one can replace home in our hearts but wouldn’t it be better to have a second home? You heard me right! Our workplace should be as cozy as our home. Contrary, not all work setting is as amiable as we imagine. We have officemates from the ends of nowhere and dropping us with cannon balls or some so-called supervisors who would like to engage in distasteful sexual behavior. These instances are big no way! Working environment should never be hostile to its employees for it will hinder the growth of the workforce thus, limiting manual labor and output.             What then is the ideal working environment? Well, it varies from one to another. Others excel in an environment where it caters good communication, great teamwork and places where they can grow professionally as well as intellectually; ideas are well received and respected and these will give them a boost of security in the organization. Human resource department in every company are mindful enough to accommodate the needs and wants of every employee. What are their strategies or innovations that give their employee’s hearts’ content? According to  Ph.D., a Pensacola, Fla.-based management consultant and author of the book “Getting Employees to Fall in Love with your Company,” has identified five things you can do to make people want to work for your organization: 1. Capture the heart of employees. To cite instances it would be balancing the life and work of the employees by giving them enough time for breaks and acknowledging or providing positive feedback. 2. Open communication. This promotes an amenable environment that allows workers to ear out their ideas, thus; giving room for growth. 3. Create partnerships. Treat employees as associates in the business world, a companion to success in that way, one is gaining respect and trust from the other. 4. Drive learning through career, peer counsel or seminars that will enrich their knowledge thus, avoiding stagnation and timidity. Offering career conversations once in a while is also fueling them to act on their hidden talents. 5. Offer professional growth. This could be done sharing the limelight by permitting an employee to handle work projects. Encourage wellness physically or mentally through free subscription to a gym or a health spa. Remember to offer rewards or allow them to choose what they want as an additional benefit.             The above guidelines are just examples of what one can do to be creative in improving workplace conditions. Diversity of ideas isn’t a barrier to create an environment a homey-effect. One Human Resources executive stated “We work hard to understand and value differences and we celebrate our diversity” (1991). The changing times in the workplace allowing the employees a wider perspective in their chosen jobs, increases their motivation to grab opportunities thus, greater chances of achieving success.   Credit:ivythesis.typepad.com

Improving the quality of a working environment

Improving the quality of a working environment “There is no place like home,” as what had Dorothy had said in the Wizard ...

Characterization Technique for Parabenes

Characterization Technique for Parabenes   Introduction             Today, cosmetics and other beauty pmroducts have a high demand among consumers, and because of this high demand, several additives and ingredients are also exhausted to be able to meet the needs of consumers. At present the use of cosmetics is essential, being crucial in adding color to the lives of many individuals, especially of women. Because of this importance, different processes are being developed for faster production of the ingredients needed in making cosmetics. Likewise, these cosmetics contain a variety of ingredients, which make them exhibit necessary properties. One of the most common active ingredients of cosmetics is parabenes, and because of its importance as cosmetics’ active ingredient, this paper discusses a specific technique in improving the characterization of parabenes in body lotions, which would be useful in enhancing its quality.   Technique: Capillary Electro-Chromatography              (1997) reports that cosmetics contain preservatives to extend their shelf life, and one of these preservatives is parabenes, which are used in many cosmetics because of their ability to impede microbial growth and prolong shelf life. However, the levels of parabenes and other preservatives must be monitored in any cosmetic product. It has been reported that some cosmetics ingredients can be regarded as allergens, and cause contact allergy, which results from a specific required hypersensitivity reaction, or cell-mediated hypersensitivity, and this involves significant and usually repeated contact with the allergen (2007). In addition, numerous allergens have been identified as causes for allergic contact dermatitis, where the most common contact allergens include nickel and fragrance mix (2007). However, like nickel and fragrance mix, preserving agents, such as parabenes can also cause allergic reactions when used in excess. For this reason, monitoring the amounts and levels of such ingredients in cosmetics must be monitored and checked. In addition, preservatives are crucial ingredients in cosmetics, specifically body lotions, because they contain organic compounds that may become dysfunctional without the reaction or effect of parabenes.               With this problem, many techniques are being developed and applied to detect levels of preservatives such as parabenes, in cosmetics products, including body lotions, and this technique is Capillary Electro-Chromatography or CEC. This technique is a fusion of liquid chromatography and capillary electrophoresis, which preserves the best aspects of both techniques ( 1997). Moreover, this is a hybrid separation method that couples the high separation efficiency of capillary zone electrophoresis or CZE, a high-efficiency separation technique for charged analytes but incapable of separating neutral molecules, and high performance liquid chromatography or HPLC, which is capable of resolving a wide range of both neutral and charged analytes. It uses an electric field rather than hydraulic pressure to propel the mobile phase through a packed bed, and since there is no back pressure, it is possible to use small diameter packings and achieve very high efficiencies (1999). This technique is suitable in examining levels of parabenes because given the characteristics of parabenes, they are hydrosoluble, insipid, colorless, and odorless substances (2006). Given these characteristics, parabenes can easily undergo the technique and can easily be identified and evaluated by using the process.   Basis for Chosen Technique, Advantages and Disadvantages             Electro-chromatography is a term used to describe narrow bore packed column separations where the liquid mobile phase is driven not by hydraulic pressure an in high performance liquid chromatography but by electro-osmosis, and using electro-osmosis to propel liquids through a packed bed are the same as for in open capillaries, leading to higher peak efficiency than is possible in using pressure driven systems such as HPLC. The driving force in electro-separation methods results from the electrical double layer that exists at the liquid-solid interface between, such as the bulk liquid and the capillary surface, the packing material and mobile phase ( 1999). In addition, under alkaline conditions, the surface silanol groups or silicon atoms to which hydroxyl substituents bond directly (2006) of the fused silica will become ionized leading to a negatively charged surface, and this surface will have a layer of positively charged ions in close proximity or the Stern layer, which are relatively immobilized. The remainder of the excess charge, which constitutes the Gouy layer, which is solvated and has the characteristics of a typical solvated ion, extends into the bulk liquid and becomes the double layer. The concentration of ions in the double layer is relatively small compared to the total ionic concentration, and falls off exponentially from the capillary surface, as does the corresponding electric potential that is proportional to the charge density. From this, it can be seen that the electro-osmotic flow depends upon the surface charge density, the field strength, the thickness of the electrical double layer, and the viscosity of the separation medium, which in turn is dependent on the temperature (1999).             Moreover, the silica gels used in the manufacture of stationary phases possess different properties, and as a result, the use of phases can produce different charge densities depending on the surface area of the silica and the acidity of the surface silanol groups. An important consideration in CEC, is the relationship between the linear velocity and the concentration of electrolyte, and since linear velocity is directly proportional to the zeta potential z, which itself decreases with increasing electrolyte concentration, it is an important variable to consider during method development. Furthermore, the driving force in this technique is the electro-osmotic flow and is highly dependent on pH, the buffer concentration, the organic modifier, and the type of stationary phase ( 1999).                  In using this characterization technique, several advantages can be determined. Primarily, using the capillary electro-chromatography technique results to shortened analysis times and enhanced performance, for handling small volumes of complex sample, such as parabenes, and reducing sample consumption is crucial in respect of clarification of physiological processes or identification of successful drug candidates and compounds, including cosmetics (2006). Secondly, using this technique would reduce materials consumption in every respect ( 2006), for in line with the primary goal, this technique would allow the identification of the compound using small amounts, and this in turn, lessens the costs of the production and hastens the operation. With this, body lotion manufacturers would not only be able to examine parabenes as preservatives, but other active ingredients as well. Manufacturers will be able to identify the amounts of preservatives in their product, improve their quality control, and enhance the value of their product in the market. Third advantage, the application of electro-kinetic separation techniques, such as capillary electro-chromatography enhances separation performance due to decreased theoretical plate heights caused by the superior plug-flow profile of the electro-osmotic flow field, which involves particulate packed or monolithic capillary columns (2006). Lastly, combining mass spectrometry to capillary separation techniques allows the use of micro-electrospray down to nano-electrospray ionization, enhancing the mass and concentration sensitivity by a multiple (2006). Because parabenes are polar compounds, it would easier for it to undergo the process, as its component properties would be adsorbed in the columns. With these advantages, it is evident that the use of this technique would enable drugs and cosmetics manufacturers to examine the amounts of the ingredients and components of their products before introducing them and selling them in the market. In addition, being able to identify the substantial amounts of preservatives in cosmetics would lessen the incidences of causing allergies to consumers.               However, despite its advantages are the said disadvantages that limit the use of the capillary electro-chromatography technique. One of its basic limitations or disadvantages is that although higher electrolyte concentrations tend to produce higher efficiencies, electrolyte concentrations can limit the percentage of organic modifier used, which can severely retard method development, brought about by the low solubility of many common inorganic buffers in organic solvents (1999). Second, high electrolyte concentrations give rise to high currents when conventional buffers are used, and leads to Joule heating followed by loss of current because of bubble formation ( 1999). Bubble formation must be suppressed to increase and maximize reliability of the data, so the Agilent CE system must be used, which is uniquely designed for operating CEC in that it can apply up to 12 bar pressure simultaneously to both vials ( 1997). Third limitation is that performing CEC on conventional CZE instruments restricts the operating conditions at certain temperatures, and because of this problem, the use of a modified CZE instrument that allowed electro-chromatography to be performed with up to 90% organic solvent at 30kV and 40C with no interference due to bubble formation (1999). However, without this instrument, performing the technique would be expensive and unreliable. Lastly and most importantly, the reliability and reproducibility of some compounds is poor, being unsuitable for routine use in CEC. With this, manufacturers must be able to produce CEC phases, allowing the highly efficient analysis of acidic, neutral and basic compounds ( 1999).   Other Techniques Used             Aside from the discussed technique, another useful technique for analyzing parabenes in body lotions is normal phase high performance liquid chromatography, which separates analytes based on polarity, and used when the analyte is fairly polar in nature, as it uses a polar stationary phase and a non-polar mobile phase (2007). Adsorption strengths increase with increase in analyte polarity, and the interaction between the polar analyte and the polar stationary phase increases the elution time, such that the interaction strength not only depends on the functional groups in the analyte molecule, but also on steric factors and structural isomers is often resolved from one another. In addition, particularly polar solvents in a mixture tend to deactivate the column by occupying the stationary phase surface, and since parabenes can be regarded as polar compounds because of their function as antimicrobial and fungicidal agents, they will be easily absorbed by the polar stationary phase.             Moreover, similar with high performance liquid chromatography, another technique can also be used, and this technique is microemulsion electro-kinetic chromatography, which is an electro-driven separation technique. Separations are achieved using microemulsions, which are nanometer-sized oil droplets suspended in an aqueous buffer ( 2003). It is application include the analysis of preservatives such as parabens, wherein in the simultaneous separation of methyl, ethyl, propyl, and butyl paraben were performed using a low-pH microemulsion. A selective separation was achieved against parahydroxybenzoic acid, which is the major degradation impurity of the preservatives, and this method was employed to assay methyl and propyl paraben. The results obtained exhibited that this method was suitable for determination of paraben concentrations, and no impurities were detected in the batches tested above the limit of detection (2003).   Performance of Technique Based on Micro Structure of Product             Results of the technique show that capillary electro-chromatography can be used for the easy determination of parabenes in body lotion and in cosmetic samples. From the experiment, graphs of the results indicate that the first eluting peak is thiourea, and as a non-retained marker can be used to indicate the liner velocity of the mobile phase through the column, which is necessary since the flow is physico-chemically dependent. Reproducibility of migration time was sufficient to identify the four peaks apparent in the body lotion analysis as parabenes, and this was confirmed by spectral analysis, which also indicated that the peak for ethylparabene contained an unknown component ( 1997). From the graphs, the components of parabenes and other preservatives present in the body lotion are evident. This would be useful to evaluate the components of body lotions, and determine its effects in the skins of consumers. In addition, using this technique would improve the quality of body lotions because manufacturers will be able to detect impurities in their product easily without the hassle of altering other components of the product. Because of the issue associated with paraben, causing cancer and other allergies, this technique and process is crucial for checking excessive amount of parabens in the final product. In this way, body lotion manufacturers will be able to lessen the incidence of contact allergies, and thus, increase the sales of their product. Moreover, because temperature is restricted, the viscosity of the final product would be sufficient for its function.   Conclusion             The use of the Capillary Electro-Chromatography is one efficient technique in determining the amounts of the components in cosmetic products, such as body lotions. The use of this technique must be developed and improved further to help detect other components in a variety of products that may bring harmful or damaging effects to the health of consumers. In this way, manufacturers of cosmetics, especially of body lotions will be able to meet the demands and the standards of their consumers, which would retain and help establish the company’s brand image and brand identity in the market. Furthermore, the use of this technique enhances the effective and efficient use of science and technology. Credit:ivythesis.typepad.com

Characterization Technique for Parabenes

Characterization Technique for Parabenes Introduction Today, cosmetics and other beauty pmroducts have a high demand amo...

Quality Improvement

Quality Improvement               The term quality means different things to different people. As defined by(1988), quality is fitness for use. In addition, quality is conformance to specifications as promoted in the manufacturing industry.   It is also defined as the judgment by customer or users of a product or service; it is the extent to which the customers or users believe the product or service surpasses their needs and expectations (1989).   Moreover, it is also means delivering products and services that meet customer standards, meet and fulfill customer needs, meet customer expectations, and will meet unanticipated future needs and aspirations (1990).               Definition of quality varies to different people. As summarized by (1992), in customer-based quality is defined as fitness for use and meeting customer expectations. In manufacturing-based, it is conforming to design, specifications or requirements and having no defects. The product has something that other similar products do not have that adds value, as defined based on the product. If defined based on the value, the product is the best combination of price and features.  Total Quality Management is a management strategy aimed at embedding awareness of quality in all organizational processes. It is a management philosophy that seeks to integrate all organizational functions like marketing, finance, design, engineering, and production, customer service and others, to focus on meeting customer needs and organizational objectives. TQM has been widely used in manufacturing, education, government, and service industries, as well as NASA space and science programs (2006).   Total Quality Management (TQM) is a method by which management and employees can become involved in the continuous improvement of the production of goods and services it is a combination of quality and management tools aimed at increasing business and reducing losses due to wasteful practices. The key principles of TQM are management commitment, employee empowerment, fact based decision making, continuous improvement, and customer focus.    Quality Improvement for Emergency Medical Services (EMS) Systems             Emergency Medical Services has served the communities into the Twenty First Century having the goal to reduce unnecessary death and disability and protecting the communities’ health. Quality for them is anything that enhances the product or services from the viewpoint of the customer or the patients. In EMS, their customer is not only the individual patient they serve but the entire community. They need to align their values with the community needs.             With the rapid change in health care environment, EMS must determine how it can best serve community health while still being the public’s emergency medical safety net. They need to provide more improved health, quality and efficiency.             To do this, EMS must establish and maintain a program for continuously monitoring and improving the quality of patient care and support services in all parts of EMS system that would encourage the leaders to integrate continuous quality improvement practices as essential parts of normal EMS routines.             In the United States, there is an increasing focus on quality which has the common thread of meeting the needs of those who pay for and use the services and products provided by an organization. All types of industries, including health care, have lowered costs and improved the quality of their operations and products by working to meet the needs of the people they serve.             Quality Improvement Methods includes qualitative and quantitative techniques, reduction of waste, benchmarking, training, customer focus and empowerment.             Quality Improvement will impact the EMS work processes, for example, changes in work site management and evaluation of work, use of self-directed teams, and re-alignment of work processes to achieve new quality targets on critical indicators.             The QI principles and methods provide a basic foundation for EMS Quality improvement efforts. QI principles and methods are applied to EMS organizations and system. Qualitative and Quantitative Techniques Tally Chart             EMS organization teams and work groups use brainstorming to generate list of process-related problems, potential solutions, approaches or options to address an issue. EMS organization has generated large unmanageable ideas so the organization uses another tool to identify the most important items on the list. Multivoting is used by EMS suited for use in large group that are reviewing long lists. Multivoting is used to help EMS organization teams focus on problem-solving and identifying high priority items in an efficient manner. It is particularly valuable in deciding issues because each member of the organization has a clear understanding of how the team will reduce the number of items to manageable proportions and how it will identify them in priority order. Multivoting allows for each member to participate equally in the decision making process.Below is the result tally sheet of the multivoting in EMS organization. Table 1. Multivoting Tally Sheet for Quality Improvement Project Selection Topic Vote Count Total 1. Inaccurate run reports ****** 6 2. Excessive response time ********** 10 3. Low scores on practical exam *** 3 4. Complaints about scheduling *** 3 5. Vehicle maintenance costs too high ** 2 6. Inability to get hospital feedback * 1 7. Excess restocking time at hospital. ***** 5 8. Intubations success rates falling ************ 12 9. Decline in fund raising revenues ************** 14 10. New member recruitment too low ********** 10   Run Chart Run chart is a type of graph that is used to see if the organization performs the work in a consistent way, or if there are obvious changes as the work progresses over the course of time. A run chart can be prepared for any characteristic of a work process that we want to measure and evaluate. In EMS organization, run charts is used to monitor characteristics or features in a number of work processes. Process characteristics that are typically measured include dimensions of quantity, quality, or time. When the data is plotted, the chart can be used to identify trends, shifts, patterns, and outliers that may exist in our work. EMS has prepared a run chart to monitor ambulance response reliability during the month of January. In the run chart below the process characteristic Number of Late Arrivals on Priority 1 Calls is plotted for the month of January. The chart illustrates that the number of late arrivals fluctuates considerably, particularly around January 6th and 26th when major snow storms occurred. Also During this period the lowest number of late responses was 5 on January 11th and 12th while the highest number of late responses was 26 on January 7th. Histogram             Histogram is one way to display the data collected to see how the organization doing at the present time. The foundation of the continuous improvement effort is data collection. Data are used to better understand variation in a work process and determine how well we are doing in meeting standards based on patient and other stakeholder expectations. A histogram is a useful tool to display these findings in order to identify our current performance and show how we are improving work processes over time It is also one way to describe and evaluate performance. In a histogram, data are grouped into defined intervals and displayed according to their frequency of occurrence in each interval. This method provides insights about performance and particularly the variation that normally occurs in work. There are various situations where histograms can be used to show how much variation exists in work. For example, in EMS organization: how much time it takes an EMS organization to complete a routine job. If repeatedly measure the length of time it takes to complete a job, it is observe that the time varies in each instance. It is also seen that all of the measurements fall within a certain range. In the example in Figure 2, the Histogram shows the response interval performance of an EMS agency to emergencies during one month. This chart shows how well the organization is meeting the needs of its patients.   Ishikawa Diagram (Cause and Effect)             A cause and effect diagram also known as the fishbone or Ishikawa diagram is used to show the causes of a problem. Since there is generally more than one cause to any problem, the diagram is used to further divide causes into groups or categories. This approach often uncovers the root causes of our problem. When the root causes are identified, we can evaluate how much each cause contributes to the problem. A problem keeps us from completing a job. Cause and effect diagram may uncover the main problem and its causes. Cause-and-effect diagrams can help clearly illustrate possible relationships between causes. They can be used to uncover the root causes of problems or specific problem steps or bottlenecks in a work process. By arranging possible causes into categories in a diagram, we can develop a better understanding of problems and the contributing factors. The main problem identified by EMS organization team was inaccurate ambulance run report. To identify the causes for why ambulance run reports are inaccurate, this cause-and-effect diagram below was developed. A quality improvement team brainstorms a list of category specific causes and marks them on the diagram. The central arrow points to the problem statement. Main branches lead to four categories of causes: People, Methods, Machines and Materials. For each major causal category, there are a number of specific causes that are shown as smaller branches. In this figure, under the major category of methods, the QI team believes that the education programs used to teach personnel how to use the run forms properly may be ineffective in changing the behaviors of existing personnel or may not be adequate to fully inform new personnel. After listing and developing this list of suspected causes, the team would decide which causes are most influential and worth pursuing. Shown below is the EMS organization Cause and Effect diagram developed by the Quality Improvement team.   Fig. 3 EMS organization Ishikawa Diagram Flow Charts             A flow chart illustrates the activities performed and the flow of resources and information in a process.  There are two types of Flow charts. These are the high level and the detailed flow chart.             The high level flow chart illustrates how major groups of related activities, the sub processes, interact in a process. High level flowcharts can readily show an entire process and its key sub processes. Meanwhile, a detailed flowchart provides a wealth of information about activities at each step in a sub process. It shows the sequence of the work and includes most or all of the steps, including rework steps that may be needed to overcome problems in the process. Hundreds of tasks are completed in order to meet specific objectives in EMS systems. It would be easier to see if how specific task contribute to their mission if they can picture the whole process. EMS organization pursuing quality improvement is constantly looking for ways to improve the effectiveness and efficiency of its work. Flowcharts are useful to generate ideas on how to be more efficient and effective. It is helpful to define and document how activities are actually performed. It can be useful to identify activities in a process that reduce our effectiveness and efficiency. It also can be used to identify conditions that cause delays and bottlenecks. This can bring focus to problems at various points within the process that need further evaluation and improvement. Figure 4 is an example of a high level flow chart of EMS organization with its sub processes that includes EMS system access, information gathering on triage, prearrival instructions and dispatch. Figure 5 is an example of detailed flow chart for two of the access and dispatch sub processes. It shows the sequence of the work and includes most or all of the steps, including rework steps that may be needed to overcome problems in the process. A quality improvement team can increase the detail to show the individuals performing each activity or the time required to complete each activity. Fig. 4 EMS High Level Flow Chart                    Fig. 5 EMS Detailed Flow Chart   Pareto Diagram                                            A Pareto Diagram is a type of bar chart in which the bars representing each problem cause are arranged, or ranked, by their frequency in descending order. A Pareto diagram is useful in interpreting data and confirming the relationships that are suggested in cause-and-effect studies. This approach is based on the idea that 80% of the problem comes from 20% of the causes; the diagram is used to separate the “vital few” problem causes from the “trivial many”. This aids in focusing on correcting or improving the vital few causes that contribute most to the problem. An example of a Pareto Chart is shown in the figure below. In this case an ambulance company wanted to identify the leading causes of incomplete data on run reports. Company managers found that about 35% (using the cumulative scale on the right) of the incomplete forms were missing the patient’s zip code. Moreover, 35% of the missing data sheets showed that the ID of other responding agencies was missing. These two data elements accounted for 70% of all run reports with missing data. With this information, managers can work with field personnel to identify potential solutions. In addition, examining the specific data elements that are most likely to be missing may point out specific solutions. In the case of the problem of EMS organization, zip code data is missing because map books in the ambulance do not show zip codes. Simply adding a zip code map book could solve the problem. The benefit of the Pareto Chart analysis was that it isolate the two major sources of missing data so that the most effective solutions can be pursued.                                                             Fig. 6. EMS Pareto Analysis             The Emergency Medical Services (EMS) leader’s role in promoting and developing quality improvement is creating and sustaining a personal and organizational focus on the needs of internal and external customers and consumers. To promote quality emergency medical services and performance excellence, leaders should demonstrate a clear commitment to the organizational mission, values, goals and expectations. The EMS organization’s chief officer or executive must spearhead leadership for QI program. All managers and leader’s must work together to set the direction for quality improvement by creating a strong patient focus,  to create clear and unambiguous statements that define organization’s mission, and values and identify operational objectives and long term expectations and to demonstrate continuous commitment to achieving organization’s quality improvement goal.  All members of the EMS system must feel empowered to make an impact on the quality of their system. Training in topics like team dynamics and problem-solving may help provide personnel with the skills needed to make the new working relationships successful. In addition, other personnel, such as dispatchers, fleet maintenance, and data collection personnel can be added to create other teams that focus on ways by which the entire EMS response, patient care and transport process can be modified to better meet patient needs. Patients and other stakeholders can also be thought of as customers of the EMS system, and, depending on how they relate to the EMS system, as either internal or external customers of the system. Focusing on patients and other stakeholders means first identifying who those individuals and entities are and then working to understand their needs and expectations. Credit:ivythesis.typepad.com

Quality Improvement

Quality Improvement The term quality means different things to different people. As defined by(1988), quality is fitness ...