18 July 2018

Why is Quality Control important?

Why should we be worrying about Quality Control in healthcare? In this blog, Improvement Advisors Anna Smith and Nynn Chang explain the basics.

Understanding Quality Control (QC) can be tricky for those of us working within healthcare, as most of the available literature and working examples relate to other industries such as manufacturing and production. This offers us the challenge of creating a quality control language, which is relevant to the healthcare industry and integrated into our daily work.

Implementing Quality Improvement, planning and assurance without a QC system means we can lack the immediate feedback loop to bring our new and agreed performance levels back, if they drift away from the goal.

Quality Control is a type of process control designed to ensure that the level of performance of a system remains stable, or in ‘control’ within new and agreed performance limits. For Quality Improvement projects – that have tested and implemented a number of change ideas to improve the level of performance of a process – it is important to establish new controls, at this level, to prevent the performance of the system from going back to its former level, or even worse, further deterioration. This is illustrated below in Joseph Juran’s Quality Trilogy diagram (De Feo, J.A., 2014).

QC is not an after event, it is continual, responsive and, preferably, often performed by the people closest to the work, whilst they are doing the actual work. A good quality control system ensures that the people closest to the work have the knowledge, tools and procedures in place to review, reflect and more importantly, react, with immediacy, to discrepancies between observed – and agreed – improved levels of performance.

Quality Control vs Quality Assurance

Whilst Quality Control and Assurance are often used interchangeably as they both evaluate performance, there are distinct differences. Quality Control is measured internally by those responsible for the work, whereas Assurance is measured after the event, and is an overview of how the system is performing by carrying out periodic checks over a snapshot in time.

Let us use an example from pharmacy to demonstrate the difference between Quality Control, Assurance and Improvement. When dispensing medication, the pharmacist or accredited pharmacy technician, will check that the right drug is for the right patient, with the right form and instruction, and labelled correctly against the prescription. This is a Quality Control process, as the intent is to control internally to prevent failure by, for instance, giving the wrong drug or dose to the patients through checking errors. Their QC system could also include a daily visual management safety board, to see their current levels of errors, and respond accordingly.

The team can then periodically perform audits to check the number of errors occurring, using data from the incident reporting system. This is an example of Quality Assurance and gives information to the pharmacy department on a periodic basis whether they are achieving an acceptable level of safety.

If the pharmacy team is unsatisfied with their current level of performance, they could start an improvement project to explore how to reduce the number of checking errors. Upon improvement, the team can then change their control system to reflect the new level of performance. Here is an example of an actual QI project completed by the ELFT Pharmacy Department.

In this animation, you can understand how Quality Control and Quality Improvement can work together:

If you are part of ELFT and would like to learn more and know how to set up Quality Control for your improvement work join one of our Masterclasses: 30 July in London and 17th September in Bedfordshire.

 

Reference:

De Feo, J.A., 2014. Juran’s quality essentials: For leaders. McGraw-Hill Education.

Copyright © 2018 East London Foundation Trust. All rights reserved.

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