Quality movement that paved the way for development of the modern quality management has evolved over a long period of time. Indeed, it can be traced back to the Middle Ages when artisans formed organized trade unions known as guilds to promote good craftsmanship. Guilds were actively involved in establishing product specifications and conducting inspections. Evolution of quality management continued at an increased pace in Great Britain in the 18th century when the factory system was developed. This was more efficient than the traditional craft system, but the factory system was still focused on product inspection. The Industrial Revolution and Taylor’s system of scientific management developed in the late 19th century resulted in increased productivity and reduced production costs. The quality movement early in the 20th century was characterized by development of quality processes and quality assurance practices in the manufacturing sector in response to the rise of the consumerism movement and significant growth in science and technology. During World War II, statistical process control (SPC) techniques, developed by Walter Shewhart, were introduced to the personnel working in the United States war industry. Following World War II, the developments in Japan in the 1950s known as the “quality revolution” triggered a similar quality movement in the United States and many other countries in the world. Foundations of the modern quality management models are based on theories, principles and methods introduced by renowned quality gurus such as W. Edwards Deming, Joseph M. Juran, Walter Shewhart, Kaoru Ishikawa, Genichi Taguchi, Philip B. Crosby, and Armand V. Feigenbaum. Over the years, Total Quality Management (TQM), Lean, Six Sigma, ISO 9000 Series Standards, Baldrige Performance Excellence Program, and similar quality management models were gradually developed, refined and applied not only in manufacturing, but also in healthcare, service, government, and education sectors. The need for a robust approach to quality management in the healthcare sector is driven by many factors including the omnipresent use of sophisticated technology, public demand for higher quality of care and improved access to services, patient safety movement, increasing complexity of care, escalating operating costs, staff recruitment and retention issues, and limited financial resources within the system.
The definition of quality continues to evolve and it depends on the industry sector, type of organization, type of products and services, customer expectations, individual perceptions, and specific circumstances. Reaching agreement on what is meant by the word “quality” is essential to select appropriate performance measures, develop strategies for continuous quality improvement, meet stakeholders’ expectations, and manage quality effectively. Traditional manufacturing organizations produce physical products and they typically define quality in terms of conformance to specifications, freedom from deficiencies, fitness for use, performance to standards, meeting customer expectations, reliability, durability, serviceability, aesthetics, safety, and value for the price paid. In contrast, the outputs of many service organizations are intangible and quality may be more difficult to define and measure. Perceived quality is an inherently subjective notion and obtaining precise measures of perceived quality may be challenging even for products, let alone services. Nonetheless, quality of services is often characterized by responsiveness to customer needs, competency and courtesy of staff, consistency, communication, availability, timeliness, promptness in resolving issues, accuracy, and many other factors. There are also many definitions, domains or dimensions used to characterize quality in healthcare. For example, the Institute of Medicine (IOM) defines quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” As outlined below, World Health Organization (WHO) defines six areas or dimensions of quality in healthcare systems.