The Juran Trilogy: Planning, Control, Improvement
Joseph Juran's Quality Trilogy provides a foundational framework for managing quality that appears on the CPHQ exam. Understanding the three interrelated processes and how they connect is essential for quality professionals.
Quality Planning
Quality planning is the process of designing products, services, and processes that meet customer needs. In healthcare, this means designing care processes, protocols, and systems that reliably produce desired outcomes. The planning process involves identifying customers (patients, families, payers, regulators), determining their needs and expectations, developing products and processes that meet those needs, and transferring the plans to operations. Poor quality planning leads to chronic waste because deficient processes are built into the system from the start.
Quality Control
Quality control is the process of monitoring performance, comparing it to goals, and taking action to close gaps. This involves establishing measurement systems, collecting and analyzing performance data, comparing actual performance to standards, and taking corrective action when performance falls outside acceptable limits. Control charts are a primary tool for quality control. The goal of quality control is to maintain the current level of performance by detecting and addressing special cause variation. Quality control alone does not improve a process; it maintains the status quo.
Quality Improvement
Quality improvement raises performance to unprecedented levels by reducing chronic waste. While quality control addresses sporadic problems (special cause variation), quality improvement addresses the gap between current performance and what is possible. The improvement process involves proving the need for improvement, identifying improvement projects, organizing project teams, diagnosing causes, providing solutions, and holding the gains. Juran emphasized that improvement is not automatic; it requires organized effort and resource allocation.
Connecting the Three Processes
For the CPHQ exam, understand how the three processes relate: planning establishes the processes, control maintains them, and improvement elevates them. Organizations need all three processes working together. Without planning, processes are designed poorly. Without control, gains from improvement are lost. Without improvement, performance stagnates.