What’s the difference between the NHS’s Quality Improvement (QI) and Quality Management (QM)? Well you could just read Juran’s Book ‘Juran’s Quality Handbook. For the origins of healthcare’s QI you could read ‘The Improvement Guide’ published by Jossy-Bass.

Juran’s Big Q and little q go some way to answering the question. 

Two definitions of Quality: 

1          Quality means those features of products or services which meet customer needs and thereby provide customer satisfaction. This is little q and the generally accepted approach to NHS QI. 

2          Quality means freedom from deficiencies – freedom from errors that require doing work over again (rework) or that results in field failures, customer dissatisfaction, customer claims, and so on. This is Big Q and the generally accepted approach to QM.

I have been working on a Roadmap and Framework that the NHS could use to move from QI to QM by focusing QI activity on process rather than product. 

Terminology is often seen as an issue in the NHS. This need not be the case. Juran offers the following definitions for two of these issues i.e. Product vs Service and Customer vs Patient. 

Product: The output of any process. To many economists, products include both goods and services. However, under popular usage, product often means goods only. 

Customer: Anyone who is affected by the product or by the process used to produce the product. Customers may be external or internal. 

Clearly, from these definitions, product and customer cannot readily be replaced by service and patient in all instances.