1 Introduction

In the first part of the text, presented in Newsletter 01, we discussed the relationship and the constant search for patient satisfaction, through the cure without harm and the use of tools and methodologies to improve overall health.

Public or private hospitals should optimize costs, motivate overall health improvement through disease prevention and ensure quality.


2 The importance of history in continuous improvement

In 1930, Shewhart, a physicist, engineer and statistician, the “father of statistical quality control” began the use of statistical tools in process improvement. He was who found predictable processes, which through control charts (Figure 2.1) became the basis of statistical process control.



This made possible to act on the processes through the PDCA and PSDA cycles, in addition to the search for predictability of process responses. However, it was only in 1980 after the reconstruction of Japan that Edwards Deming, also a statistician, recognized for the improvements in production processes in the United States, took these techniques to rebuild the country, and through the Toyota System applied the culture of quality and process improvement and emerged as a great economic power.

After the development of the Toyota Production System, process improvement became popular as a strategic advantage, efficient production involving employees, standardized and Just in time. Figure 2.2 shows more characteristics of the process.



In the same period, Lean Six Sigma also emerged in the search for process improvement in work routines. In order to identify and eliminate waste by reducing costs and increasing quality based on structured information.

Toyota and Lean systems affirm that front-line employees should be in charge of improving processes and, therefore, they are participants in the improvements.


Even talking about the importance of improvement in the healthcare history, it is necessary to understand the four pillars of deep knowledge, shown in Figure 2.3 These four pillars enable changes to generate improvements.



2.1 Systemic vision

The organization is a set of processes that has the purpose of satisfying the needs of a client, which in health is the treatment of some pathology, or a consultation, or emergency care, among others. Often the lack of alignment of processes is responsible for losses, such as adverse events, unnecessary costs, re-elaboration, long waiting time and therefore it is very important to see the correlation between all processes with a single purpose.


2.2 Process quality knowledge

It is necessary to know how to generate specific knowledge within the organization, for example, in the case of hospital pharmacies, pharmacy processes directly influence the administration of drugs to patients, and therefore all pharmacy staff must be aware and very well trained on the importance of drug unit-dose process, because an error can be responsible for adverse events, even the death of patients. In view of this, continuing education of the pharmacy sector and all hospitals related to unit-dose process is essential.

  • Study of variation

Variation is inherent and natural to processes; several factors lead to changes in outcomes. Therefore, it is necessary to study and learn from these variations.

2.4 Culture

All organizations are made up of people and it is necessary to understand the characteristics and distinctions so that it is possible to achieve teamwork to achieve the purpose of the organization. That is why happy, satisfied and committed employees for the company’s purpose are fundamental.

Culture is values, attitudes, habits, typical behaviors, shared beliefs. Culture determines how an organization function.

Quality methodologies and tools teach you to understand and apply the concepts of the pillars of deep knowledge in order to generate improvements that promote strategic change and advantage.

At this point, three questions presented in Figure 2.3 are able to direct what improvements should be important: