Réference à rappeler : Planification Stratégique et Amélioration Continue en Enseignement Supérieur, Recherche et Hôpital, Mastère NQCE session professionnelle, UW-Madison, CQPI, 2000, p 61,http://www.utc.fr/~farges/Qualite/Q_Madison/Madison.htm Reference to make: Strategic Planning & Continuous Improvement in Higher Education, Research & Hospitals, Mastère NQCE professional session, UW-Madison, CQPI, 2000, p 61, http://www.utc.fr/~farges/Qualite/Q_Madison/Madison.htm

Strategic Planning & Continuous Improvement in Higher Education, Research & Hospitals "Experiences at UW-Madison and Transfer to the French Context"

Etude réalisée de mars à mai 2000 à l'Université de Madison - Wisconsin - USA par : Working place UW-Madison, from March up to May 2000, report written by :   Gilbert FARGES, enseignant-chercheur en technologies biomédicales à l'Université de Compiègne, responsable et animateur de formations d'ingénieurs et de techniciens supérieurs biomédicaux hospitaliers. Mes activités d'enseignement et de recherche m'amène naturellement à m'intéresser aux développements des démarches qualité dans l'enseignement supérieur. Gilbert Farges, teacher and researcher in biomedical and hospital clinical engineering at the University of Technology of Compiègne. Since a long time, I am very interested to develop and implement quality management in Higher Education, Scientific Research and Hospitals.   UTC, BP 20.529, 60205 Compiègne Cedex, France, Tel : [33] (0)3 44 23 44 58, Fax : [33] (0)3 44 20 48 13 E-mail : gilbert.farges@utc.fr           URL : http://www.utc.fr/~farges

Contents

Acknowledgments                     Aims of the project


Chapter 1: Quality Management at UW-Madison

A) About University of Wisconsin- Madison
B) Strategic Planning and Continuous Improvement
C) Operational organization around Quality at UW-Madison

Chapter 2: Quality Teaching & Learning Experiences at UW-Madison

A) UW-Madison Teaching Academy
B) Creating a Collaborative Academic Environment (CCAE)

Chapter 3: Research & Quality Management Experiences at UW-Madison

A) Continuous Improvement at RSP
B) Biomedical Engineering Department

Chapter 4: University Hospital & Quality Management Experiences

A) About University of Wisconsin Hospital and Clinics
B) Quality Improvement Department
C) Medical Physics Department
D) Clinical Engineering Department

Chapter 5 : Synthesis and transfer possibility to the French context

A) Quality in Research at UTC
B) Quality in Hospitals

Conclusion                        Bibliography

Appendix

A: OQI : Office for Quality Improvement
B: CQPI : Center for Quality & Productivity Improvement
C: The 14 points of Deming’s quality management
D: Quality websites

 

I thank the UW-Madison teams, researchers, members, staff, students, and especially CQPI, for their open-mindedness, confidence and friendly help and collaboration during the stay and I will enjoy any future scientific collaboration:

• François Sainfort, Ph.D., Director of CQPI for his invitation to share the great quality experiences at UW-Madison,
• George Box, Ph.D. and Professor Emeritus, for sharing his great scientific knowledge during CQPI seminars,
• Pascale Carayon, Ph.D. and Peter Hoonakker for their very friendly welcome and interest,
• Marlene Beilman for her useful help to plan and manage my stay (before, during and maybe after ?),
• Murat Kulahci, Ph.D. & Ernseto Barios for their friendly advises,
• Mary Ellen Hagenauer, Kassy Hilber, John Tyssedal, Ph.D. & Ben-Tzion Karsh, Ph.D. for their daily kindness,
• Maury Cotter for her helpful meetings despite an overbooked agenda !
• Lois Brako, Ph.D., for her very helpful and documented meeting to understand quality at RSP,
• Katherine Sanders, Ph.D. and Christopher Carlson-Dakes for their friendly meeting about the very impressive goal to create collaborative environment in teaching, learning and research in order to serve the Vision of the University,
• Ann Zanzig and John M. Elliott for their very understandable workshop about strategic planning and continuous improvement,
• John Webster, Ph.D. and Nancy Webster for their kindly welcome and help during my stay,
• Nancy Speck, Jack Bowhan & Carl Selbo for their welcome, helpful meetings and documentation and maybe future collaboration?
• Bruce Thomadsen, Ph.D. & Frank Narallo, Ph.D., for their useful meetings, advises and interest about my project,
• William Bloomer for his discussion about clinical engineering.

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Like teacher, researcher and biomedical engineer, I always have been interested by techniques and methods to manage technology, innovation and organization.

In France, a recent law¹ requests quality in public or private hospitals and has created a strong movement in favor of quality approaches and improvement methods into the organizations.

In the field of the higher engineering education and research, a recent study² also shows that European Union recommends to develop assurance quality management methods in Colleges and Universities in all European countries, at all levels in the teaching area and even if possible in research³ .

In order to be able to efficiently teach, understand, research, plan and manage quality in my professional field, I decided one year ago to attend a higher engineering diploma in quality. It has been not very easy to plan and do it in the same time of my busy job. But with a strong and well planned organization, a comprehensive family (and wife), friendly colleagues, in Spring 1999 I could attend the first theoretical part of the training.

Spring 2000 is the planned period for the second part of the course: the practical and professional training which I wanted in a well experimented university area, in order to understand the keys to successfully manage a quality development. I am very grateful to the Center of Quality and Productivity Improvement of the University of Wisconsin-Madison, and especially to its Director François Sainfort, to share with me its experience and knowledge.

This CQPI stay is the first half part of my practical training session, because I will go to Montreal University for the second and last part, more focused about quality management for hospitals.

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A) About University of Wisconsin-Madison⁴ :       (source : http://www.news.wisc.edu/welcome/mission.html)

Madison (200,000 inhabitants) is the capital city of the state of the Wisconsin (5,000,000 inhabitants) (figure 01). The median age of the Madison population is 33 and almost 70% to 75% of Madisonian are under 44⁵ .

Fig 01: Geographic situation of Madison (left) and the Wisconsin State Capitol (right)

“Entrepreneur Magazine”⁶ ranks Madison as one of the top 5 cities in the USA in which to start a business. More than 350 firms in the Greater Madison Area are defined as high-tech: 25% of these firms are in manufacturing and service sector (biotechnology, medical/biomedical research, micro-electronics, pharmaceutical, contract research and development, software...)

Research activity on the University of Wisconsin-Madison campus is a major stimulus for growth in the area's economy. Over the last five years the number of high-tech firms has grown 20%. The University of Wisconsin-Madison ranks in the top echelons of American research universities. UW-Madison annually receives total research funding exceeding $363 million. According to the latest figures available from the National Science Foundation, this makes the University of Wisconsin-Madison the third largest funded research university in the USA.

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Founded in 1849, the university is a public, land-grant institution that provides on a single campus a complete spectrum of liberal arts studies, professional programs and student activities. UW-Madison academic reputation has been rated among the top 10 in many areas of study since 1910.

     
Fig 02: Some views of the campus of the UW-Madison

The primary purpose of the University of Wisconsin-Madison is to provide a learning environment in which faculty, staff and students can discover, examine critically, preserve and transmit the knowledge, wisdom and values that will help ensure the survival of this and future generations and improve the quality of life for all. The university seeks to help students to develop an understanding and appreciation for the complex cultural and physical worlds in which they live and to realize their highest potential of intellectual, physical and human development.

Some statistics (1999):

Students: 40,000
Costs/year: $11,000 (non-resident: $20,000) (includes room, books, supplies...)
Alumni: 320,000
Staff: 18,000 (Faculty: 2,000 Academic: 5,500 Classified: 5,000)
Campus (acres):
Main: 1,000 (400 ha) Arboretum 1,300 (530 ha) Experimental Research: 6,000 (2500 ha)
Academic programs: Majors: 146 Master’s: 169 Doctoral: 125
Courses offered: 4,546 Sections: 13,112
Classroom space: 431,000 sq. ft. (40 000 m²)
Research Laboratory space: 1.6 million sq. ft. (150 000 m²)
% of students owning computers: 65%
General-access computers on campus: 1,100
Budget: $1,250,000,000 (State support: 28% Research: 40%)
US Rankings:
Research & development expenditures: 3rd
Voluntary support: 5th (among public universities: 1st)
Number of doctorates granted: 2nd

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B) Strategic Planning and Continuous Improvement:

B1) The Quality Culture at UW-Madison:

The first impact of quality at UW-Madison is already visible on its website where the Chancellor David Ward presents the annual report and the perspectives. For the next decade, UW-Madison has planned an ambitious management project called “A vision for the future” which gives the priorities, the objectives of progress and the strategic planning process [Ward, 1999].

Two diagrams show very clearly the effect of such quality approach on the management organization at UW-Madison. First, figure 03 shows the strategic planning used since 1988, which is based on Deming’s quality principles, ie Plan, Do, Check, Act.

Fig 03: The Deming’s method at UW-Madison Madison since 1988 up to today

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In this strategic planning, the most important is the “Check” after “Plan” and “Do”, which involves the obligatory measure of the process results. This Check process and the involved analysis of the gap between results and attempts, have a direct effect on the future planned decisions. That is the reason, it is very important to accurately define indicators and to rigorously manage the organization in order to obtain them as precise and credible as possible.
In a such “looped management system”, the University is a learning and thinking organization which is able to measure its progress, to understand its gaps and to improve its processes [Cotter, 1996]. It is expected, and now proved by experience, that the energy, time and money spent by the organization to provide all services according to its mission, is better controlled than in an opened management system where all decisions are only planned and done without serious and quantified success feedback for the upper management team.

The second diagram (figure 04) shows how mission can be dispatched in several priorities after filtering by the vision themes for the future at the University.

Fig 04: Missions and effects of the “Vision for the future” project on UW-Madison priorities

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B2) Strategic Planning:

The quality concept used permanently and at all levels at UW-Madison is the “Strategic Planning Model” (figure 05) [Paris, 1999b]:

Fig 05: Strategic Planning Model

Strategic planning is a means of establishing major directions for a department, research team or all other entities at the University. The aims are to concentrate resources in a limited number of major directions in order to maximize benefits to stakeholders (students, employers of graduate, funding agencies, and society, as well as internal stakeholders such faculty and staff). The methodology is based on Deming’s philosophy which advises to manage all processes with a feedback about gap between results and attempts in order to analyze them and to find solutions to improve processes [Deming, 1994]

Though strategic planning is a structured approach to anticipating the future, it is not long-range planning. Strategic planning is much more sensitive to the external environment than long-range planning which is traditionally inwardly focused with goals and objectives taking minimal attention to the larger system in which the institution functioned. Strategic planning relies on information from internal and external stakeholders regarding their needs, expectations and requirements as the foundation for planning. If traditional long-range planning assumes that the future will be a linear extension of the present, strategic planning is much more likely to result in a deliberate shift in direction or refocusing direction in light of changes, actual or anticipated [Paris, 1999b].

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B3) Continuous Improvement:

The continuous improvement process generally used at UW-Madison is a seven steps process (figure 06) based on Juran’s and Deming’s quality management methods [Deming 1989; Juran 1992]

Fig 06: The 7 step process used at UW-Madison

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An “Accelerated Improvement Process” has been designed by the Office for Quality Improvement⁷ at the end of 1999 that enables a team to quickly improve or create a process (figure 07) [Cotter, 1999].

Fig 07: “Accelerated Improvement Process” designed by OQI at UW-Madison

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The requirements of the Accelerated Improvement Process are leadership commitment and support, the expertise and knowledge of staff and customers, eventually one facilitator. This accelerated process is useful for already experimented team in quality management and continuous improvement. The principle of the Accelerated Improvement Process is as follows:

- a majority of the project work (data collection, flowcharting, planning etc...) is done outside formal meeting time.
- meeting time is spent on generating solutions, prioritizing solutions and developing implementation and action plans.
- multiple tasks are done simultaneously.
- team meeting time is concentrated into 2 very structured meetings.

All quality plans developed by research teams, academic departments or other entities at UW-Madison need measures of success. They are the criteria that show the impact of the quality improvement, they can be quantifiable or qualitative, but they must be observable in some way. Without data on what is being accomplished in the quality plan, there are little or no foundation for decision making or improvement. Without data, anyone’s opinion is as good as anyone else’s. Without knowing in advance what “success” looks like, it is very difficult to implement any plan. In order to help everybody concerned by measures of success, a very interesting, simple and efficient methodology is proposed at UW-Madison [Paris, 2000].

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C) The operational organization around Quality at UW-Madison:

There are several organizations, office and center, at UW-Madison in order to help it to reach its mission, objectives and priorities.

Office for Quality Improvement (OQI)⁸ :

Established in 1994, OQI provides provides consultation and facilitation services for academic and administrative units throughout the UW-Madison. Its position at Bascom Hall, closed the Chancellor’s office, shows clearly the strategic importance of OQI for the University.

OQI facilitates the use of planning and improvement methods for any voluntary university teams, helps them to identify their aims and suggests methods for achieving them. A dozen of members and consultants⁹ assist the teams with all aspects of a quality project like its design, strategic planning, improving processes, training etc...

They use all well known quality management tools like flowcharts, cause-effect diagrams, Pareto charts, histograms, check sheets, control charts and scatter diagrams [Mizuno, 1988].

They already have served numerous university customers like the following academic departments or services:

Academic Advising campus-wide	Academic Services, School & Education	Academic Students Affairs, Grad School
Accounting	Arboretum	Center for Biology Education
Chemistry	Dean of Students	Dean’s Council
Division of Academic Services	Educational Psychology	Engineering
Entomology	Graduate School	History
Housing	Integrated Student Information System	Journalism & Mass Communication
Mathematics	Medical School	Pathology & Laboratory Medicine
Provost’s Staff	Registrar’s Office	Research & Sponsored Programs
Student’s Academic Affairs, L&S	Wisconsin Food System Partnership	Zoology

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The quality projects currently in development are:

- Expediting Grant Proposals: A Guide for Improving the Grant Proposal Process with Examples from the Department of Medical Microbiology & Immunology
- Using Quality Function Deployment to Improve Academic Advising Processes
- How TQM Helped Change an Admissions Process
- Redesigning the Industrial Engineering Curriculum at UW-Madison for a Changed World
- University Housing Food Service Improvement Project
- Chemistry Department Filing System Improvement Project (coming soon!)

Of course, OQI uses also for itself total quality management (TQM) methods and has some operating principles to conduct its daily business like to listen carefully the clients, achieve their outcomes, model the best practices of a quality-driven organization, share ideas, successes and failures, respect diversity and personalities in the interactions, explore alternatives and take risk in order to create change and continuous improvement.

Its web site provides a lot of useful information and tools about Strategic Planning and Continuous Improvement. Since January 1998, the “Exchange” newsletter is online on the net¹⁰ . This bimonthly newsletter of about 15 pages is edited and distributed freely in order to circulate the quality “culture”, methods and tools over the university.

The budget of OQI is entirely provided by UW-Madison in order to allow the stronger focus on its priority aims to serve as better as possible Mission and Vision of the University. There is no financial consideration with university customers and according OQI Director it is an attractive thing for those interested by quality but not ready to spend a lot of time and money for that. OQI staff members provide a lot of training sessions on quality tools, methods and management. They don’t use any specific quality management software, only Internet browsers and classical word processors, e-mail and database software. They publish a lot of internal guides about quality which are of course freely distributed and easily accessible for everybody.

The measure of success for OQI is based on the results of the quality projects of their customers. The ratio of projects with results on total managed projects as well as feedback and repeats of customers are good indicators of the OQI processes.

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Center for Quality and Productivity Improvement (CQPI)¹¹

It is a research center founded in 1985 by Professor George E.P. Box and the late Professor William G. Hunter. Its mission is to conduct innovative practical research on concepts and methods of quality improvement, to provide a national and international forum for the exchange of ideas among faculty, students, experts, and practitioners from industry, government and academia; and to disseminate research findings and ideas through effective instructional and communication approaches. Its Director is François Sainfort who I thank a lot for its invitation to stay at CQPI in order to study quality experiences at UW-Madison.

For that CQPI disposes about 300 m² in the WARF¹² building within University Campus, has about 20 faculty affiliates, 6 staff, 10 graduate students, 10 external members, and 5 to 6 visiting researchers per year. In order to keep the best scientific level, any faculty member is permanently affiliate at CQPI, instead all have a university department where they teach and research. CQPI is a center where the multi-disciplinary quality problems are studied, requiring input from and interaction among many different fields. Thus it regroups different origins of faculty members interested to work about quality problems. Three mains sponsors help CQPI: UW-Madison College of Engineering, Graduate School of Business and the College of Letters and Science via the Department of Statistics. The industrial and scientific research comes from big international companies but also from public resources like the National Science Foundation, the State of Wisconsin, and the UW-Madison Graduate School. More than 170 reports (part of them accessible online¹³ ), 250 journal articles, 9 books have been authored, co-authored and/or issued.

CQPI provides also courses and high-level seminars to train experimented engineers, managers, statisticians about the last techniques, methods and mathematical tools used in quality control or management.

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Quality Assurance Systems Research Consortium (QASRC)¹⁴ :

QASRC is a consortium which made business in partnership with the University of Wisconsin-Madison. It conducts study, development or applied research on problems and issues related to implementing quality assurance systems. The studies may be done by faculty, student teams or independent graduate students. The consortium holds an annual conference and several seminars or workshops for engineers and managers.

Madison Area Quality Improvement Network (MAQIN)¹⁵

MAQIN supports workplace learning, growth and change for individuals and over 170 organizations in Wisconsin and surrounding states. Over 60 programs and learning events a year, and customized assistance to members are provided to the members. MAQIN members are diverse including the private and public sectors, manufacturing and service sectors.

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A) UW-Madison Teachnig Academy¹⁶ :

In response to a recommendation by the Committee on Teaching Quality, Evaluation, and Rewards Committee (1989 and 1992), the Faculty Senate created the Teaching Academy on December 6, 1993. The Teaching Academy, composed of faculty members and instructional staff, provides leadership to strengthen undergraduate, graduate, and outreach teaching and learning at the University of Wisconsin&endash;Madison.

The long-term goal of the Teaching Academy is to promote effective teaching and learning on this campus and also nationally, by encouraging innovation, experimentation, and dialogue among faculty, instructional staff, and teachers of the future. Thus, the Teaching Academy is in charge to encourage Excellence in Teaching and to maintain and further the diversity of teaching excellence across the university.

The basic functions of UW-Madison Teaching Academy are the following:

1. Provide a forum for dialogue on effective teaching-learning.
2. Clarifying criteria and procedures for assessing the quality and effectiveness of teaching
3. Communicate the best practices of teaching-learning.
4. Encouraging provision of assistance and resources to enable interested faculty members and instructional staff to improve teaching
5. Link individuals interested in improving the teaching-learning process.
6. Sponsor professional development events.
7. Analyze issues and make recommendations on University policies affecting teaching-learning.
Providing opportunities for discussion of issues in teaching, research, scholarship, and learning.
8. Create a learning community for sharing for the future.

The Teaching Academy includes outstanding teachers who represent a broad range of content, teaching styles, and learner characteristics. It focuses campus and departmental deliberation on issues that are central for strengthening teaching and learning.

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Like a lot of Departments or Services at UW-Madison, the Teaching Academy uses also strategic planning for its development and management (figure 08):

Fig 08: Strategic Planning of the Teaching Academy

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Issues and results:
Yearly, the Teaching Academy identifies and addresses particular issues to the preceding Committees (Teaching Quality, Evaluation, and Rewards):

1. What is involved in good teaching? Dialogue could focus on discussion of the mission of the university in relation to teaching. Central to this dialogue is an exploration of what counts as good teaching and how it is rewarded. Does the current system encourage or discourage a serious interest by faculty and staff in teaching? Ways to reward departments that give special attention to teaching improvement could be explored.

2. How can we develop new partnerships with students so that they feel actively involved in the educational process instead of being passive consumers? What changes in curriculum, in the organization of classes and in pedagogy would lead students to become more involved? In what ways can we promote active learning by students?

3. How can we develop criteria for judging excellent resident instruction and outreach teaching? Teachers often feel uncomfortable with the way in which they are evaluated by students. Some students are concerned the evaluation tools used by teachers are inadequate. Issues of how to measure both teaching and learning are complex. Other vehicles of evaluation could be explored?

4. How can we help new and continuing teachers develop their teaching approaches? What strategies and methods work best in the classroom? How can we recognize the importance of a diversity of effective teaching styles and methods? How can we encourage sharing among teachers to offset isolation and to enrich and sustain career-long faculty development?

All members of the faculty and instructional academic staff are eligible to be Fellows in the Teaching Academy for three-year. The selection of Fellows reflects the scope of campus perspectives and a variety of teaching approaches.

The work of the Teaching Academy occurs within five Task Forces. These were created to provide a mechanism that generates recommendations for constructive change. In addition, the meetings, interest groups, workshops, seminars, and conferences are designed to provide opportunities for learning and sharing of what others have done and what ideas and possibilities are appropriate for this campus.

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The 5 thematic Task Forces are:

Being New and Teacher Preparation

How to support, encourage, and share teaching experiences with beginning colleagues as well as graduate students who are considering the teaching profession. The 1998 report on ”Perspectives on Being New and Teacher-Scholar Preparation”¹⁷ is available on the web.

Celebrating Effective Teaching

How to communicate good teaching and provide guides and examples of outstanding university teaching which could provide benefit.

Instructional Technology

How to rigorously evaluate the impact of information technology on learning, which could be profound if it is implemented effectively, supported adequately. In May 1997 this Task Force completed a “white paper on instructional technology”¹⁸ available on the web.

Peer Review of Teaching

In conjunction with the American Association of Higher Education¹⁹ , Peer Review of Teaching Project, the Teaching Academy is monitoring this effort to provide input and encouragement for a valid experiment on the UW-Madison research campus. Peers are essential for any valid assessment process and how to do this efficiently is the challenge ! An action plan²⁰ is available on the web.

Student Assessment of Learning

In order to examine the available methods of assessing the students' perceptions of their learning experience. The validity of student questionnaires, the content of the questions, the use of the information, and the evaluation of the results by peers are all being examined by this task force so that appropriate recommendations can be generated.

Results of the Task Forces works are very operational, like for example to provide a “Teaching Ideas Network”²¹ for faculty/staff who are searching for assistance with their teaching. Some Teaching Academy members interested in working with faculty who are in search of a solution to a teaching problem, are listed on the web in order to be contacted.

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B) Creating a Collaborative Academic Environment (CCAE)²² :

Creating a Collaborative Academic Environment is a movement that evolved out of Katy Sanders’ Industrial Engineering dissertation in 1993. Participants in an experimental program found the experience so rewarding that they asked the Dean to establish the program college-wide.

At the heart of all programs and projects lies the intent to give faculty and staff a place to explore non-traditional approaches to work and collaboration. One of the goals of CCAE is to provide a safe place and stimulating activities for participants to address complex issues, consider new directions, create their own solutions and implement them with supportive from diverses disciplines.

Creating a Collaborative Academic Environment (CCAE) designs and supports cross-disciplinary professional development programs for faculty and staff volunteers to work in small groups to explore theory, question personal assumptions, create new approaches to work, and nurture each other's growth in teaching, research, and service.

Several programs designed by CCAE staff, as well as programs developed in collaboration with other offices on campus contribute to the campus Vision Priorities of reconceptualizing undergraduate education, encouraging collaboration, and rethinking the organization.

Creating a Collaborative Learning Environment (CCLE)²³ :

The Mission of CCLE is to implement a grass-roots, faculty advised professional development process that centers on the construction of knowledge in faculty teams. CCLE provides a support structure for group work, exposure to general educational information, and preparation for practitioner action in the classroom. Volunteers are asked to make a commitment to attend team meetings, to share their experiences in teaching and learning, to cooperate with other participants, to consider new ideas, perspectives, and techniques, and to eventually be a resource for each other. It is a unique opportunity to collaborate with colleagues to explore learning at UW-Madison !

Since 1993, over 130 faculty and instructional staff from 54 departments have participated in CCLE. Each year about 20-25 new participants begin the CCLE program and approximately 20 return to participate in advanced teams. Participants are asked to make a commitment to:

- focus on developing and expanding a deep and personal understanding of the learning process as a precursor to talking about teaching
- attend weekly team meetings (1.5 h/w)
- share experiences in learning and teaching
- be open to engage new ideas, perspectives and techniques
- be a resource for other faculty over multiple years

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Peer Review of Teaching (PRoT)²⁴ :

Peer review of teaching refers to the participation of colleagues in the development and/or evaluation of one’s teaching activities.

1) By colleagues, means persons who engage in the same or similar kinds of educational activities, persons who share content expertise, or persons who bring relevant specialized skills to the task of peer review.
2) By development, means the creation or evolution of educational activities over time. Formative review refers to activities designed to contribute to the development of teaching. A formative review results in feedback to the instructor.
3) By evaluation, means the assessment or appraisal of the quality of someone’s teaching. Summative review refers to activities designed to produce or provide input to such an evaluation. A summative review usually results in documentation that may be reviewed by others.

An other very interesting program still in project is "Creating a Collaborative Research Environment" which should be organized like CCLE.

All of these programs are free for participants who have not to expect any direct professional evolution after they completed them. The progress, the wanted improvement, is only for the intrinsic development of each individual, and their motivation must be only to get better in your job, to be curious to share ideas and experiences with other people who work in very different areas.

The measure of success and data come from interviews of each participants and evaluation criteria are only qualitative.

There is no doubt that these methodologies to improve Teaching, Learning and maybe Research environment at the University will provide the best way to reach "Excellence".

Some authors and faculty propose to implement Excellence in Higher Education from the Malcolm Baldrige criteria [Ruben 1997, Steudel 1999]. It is obvious that such plans must be developed from a strong commitment of all faculty and staff members, that is why the CCAE approach is promising for the future at the UW-Madison.

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A) Continuous Improvement at Research & Sponsored Programs²⁵ :

The Office of Research and Sponsored Programs (RSP) promotes and facilitates research, education, and outreach missions of the University by supporting and administering extramural sponsored programs.

The Office of Research and Sponsored Programs (RSP) is responsible for the final review, negotiation and submission of all grants and contracts. RSP provides the financial administration of sponsored research grants and contracts by preparing financial reports, submitting invoices and processing payments. The primary functions include the following:

- Transmit extramural support applications (approx. 3,000 per year)
- Negotiate and accept awards on behalf of The Board of Regents of the University of Wisconsin System. ($553 million in FY99)
- Administer accounts on a daily basis (approx. 9000 active accounts)
- Provide training on UW-Madison and Sponsor's policies/procedures for administrators and investigators
- Maintain the extramural support database
- Collect receipts and prepare financial reports/invoices
- Manage the personnel activity reporting system (PAR)
- Perform indirect cost studies (Facilities and Administrative costs)
- Produce a monthly electronic newsletter

It is integrated into the Graduate School Administration Organization which contains two Services : Graduate Education and Admissions Services; and Research Administrative Services where is RSP.

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Since 1997, RSP is performing a continuous improvement on its processes and the strategic planning methodology is used:

- Mission statement (presented above)
- Operating principles: Professionalism, Quality of Service, Office Environment
- Customers: definition of the primary and secondary customers
- Critical processes:

Proposal Submission:

- Encouraging the pursuit of extramural funding and identifying funding opportunities
- Proposal preparation
- Regulatory compliance

Grant and Contract Awards:

- Setting-up the Award Account
- Managing the Award

- Trends: list of trends influencing Vision and Priorities for RSP
- Vision: RSP is the respected leader of the campus Research Administration Team, fostering UW-Madison’s continued research preeminence.
- Strategies to achieve the Vision: Build capabilities and independence, Redesign information technology infrastructure, Promote professionalism
- Quality action plans (6 months, one-year, more than one-year)

According to Lois Brako, Assistant Dean at RSP, in charge of this quality development, it is a good way to clarify the activities of everybody into the Service but also with customers or stakeholders. Now, a clear dispatching of roles and responsibilities, between the Principal Investigator (PI), the Chair of the Service or Department, the Dean or Designee and RSP, is defined, available, easily accessible²⁶ and used by every researcher at UW-Madison.

RSP provides also a lot of training, seminars and helpful information guides about safety in experimentation²⁷.

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B) Biomedical Engineering Department (BME)²⁸ :

Biomedical engineering began at the UW-Madison in 1962, and research topics include such diverse areas as neurological modeling, new treatments for Alzheimer's disease, biomedical sensors, cardiovascular system simulation, biomedical instrumentation, biomedical computing and signal processing, imaging, biomechanics, rehabilitation engineering and ergonomics, bio-electronic systems and interfaces...

The Biomedical Engineering Program also received a $1 million grant from the Whitaker Foundation²⁹ , under that organization's Special Opportunity Awards in Biomedical Engineering program. This has enabled the UW-Madison BME Program to continue growing, and there are many exciting new developments anticipated in the next few years as a result of this support. (A list of funding agencies³⁰ containing helpful information for researchers in all fields of science and technology was conceived by Pr Gabriel Robins³¹ . There is also the service provides by RSP at http://www.rsp.wisc.edu/funding.html).

Quality in this BME research area is achieved by high motivation of students, strong and efficient team working, high rate level of international scientific communications, publications and books. The different security and safety problems which could appear about experimentation, are well managed by efficient student training in one of the numerous specific courses available at UW-Madison. The capitalization of the scientific knowledge is done naturally by the know-how of the permanent staff like Professors or Assistant Professors.

BME Department is a recent one at UW-Madison and its Chief contacted recently the Office of Quality Improvement (OQI) in order to start a strategic planning approach. This one is only at the beginning but will allow to the BME research team to focus on priority selected areas, after having clearly defined Mission and Vision of the research team. That could be a very efficient way to anticipate the future and to reach the Excellence in their research area.

The Master of Science degree in BME exists at UW-Madison since 1974. In recent years, the BME degree program has greatly expanded. UW-Madison now offers degrees at the undergraduate and graduate levels (BS, MS & Ph.D. in Biomedical Engineering). The Bachelor of Science degree began in 1998 with a first promotion of 20 students, the next year the second had about 40.

UW-Madison doesn’t provide a Clinical Engineering program (in 4 years to teach clinical engineers who work in hospital) neither a Biomedical Engineering Technology diploma (in 2 years to teach hospital biomedical technicians). In the USA, the 16 Universities which provide Clinical Engineering programs and the 8 Universities, Colleges or Institutes which teach BME technology are listed in the following web list :

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US Universities which provide Biomedical Engineering Courses [accreditation date]:
(source: http://www.abet.org/accredited_programs/EACWebsite.html)

16 Programs accredited by the Engineering Accreditation Commission (course level: engineer):

Duke University, Durham, NC [1972]
Rensselaer Polytechnic Institute, Troy, NY [1972]
Case Western Reserve University, Cleveland, OH, [1977]
Louisiana Tech University, Ruston, LA [1978]
Tulane University, New Orleans, LA [1981]
Northwestern University, Evanston, IL [1982]
Boston University, Boston, MA [1983]
The Johns Hopkins University, Baltimore, MD [1983]
Marquette University, Milwaukee, WI [1983]
University of Iowa, Iowa City, IA [1986]
Wright State University, Dayton, OH [1988]
The Catholic University of America, Washington, DC [1990]
Vanderbilt University, Nashville, TN [1992]
Milwaukee School of Engineering, Milwaukee, WI [1990]
University of Miami, Coral Gables, FL [1997]
University of Wisconsin-Madison*, Madison, WI [1998] (*: not still officially accredited)

8 Programs accredited by the Technology Accreditation Commission (course level: technicians):

State Technical Institute at Memphis, Memphis, TN [1976]
Pennsylvania State University, Wilkes-Barre, PA [1979]
Pennsylvania State University, New Kensington, PA [1985]
Cincinnati State Technical and Community College, Cincinnati, OH [1988]
State University of New York at Farmingdale, Farmingdale, NY [1989]
Owens Community College, Toledo, OH [1989]
Gateway Community-Technical College, New Haven, CT [1996]
Chattahoochee Technical Institute, Marietta, GA [1999]

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Chapter 4 University Hospital & Quality Management Experiences at UW-Madison

A) About University of Wisconsin Hospital and Clinics³² :

University of Wisconsin Hospital and Clinics (UWHC) (figure 09) has been established by the Wisconsin Legislature in 1924. It has a fourfold mission: delivery of comprehensive, high-quality patient care; education of the next generation of health care professionals; research leading to advances in medical care; and service to communities throughout the state. In addition of the UW hospital, there are 12 clinics associated to the UWHC system.

Fig 09: University of Wisconsin Hospital and Clinics

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For 1999, its budget is about $360 million with the following statistics :  (source:http://www.uwhospital.hosp.wisc.edu/)

- Inpatient Admissions: 21,000
- Outpatient Visits: 460,000
- Emergency Department Visits: 30,000
- Physicians: 700 (active only)
- Number of Employees: 4,000 full-time equivalents

- 474 beds, whose:

- Five intensive care units with a total of 59 beds
- Trauma and Life Support Center (Level One): 24 beds
- Pediatric ICU: 12 beds
- Cardiac ICU: 8 beds
- Cardiothoracic surgery ICU: 8 beds
- Burn unit: 7 beds
- 20-bed psychiatric unit
- 10-bed security unit
- More than 80 outpatient clinics, including primary care

The major programs of the UWHC are:

- UW Comprehensive Cancer Center: one of approximately 35 federally designated centers for cancer treatment and research.
- UW Children’s Hospital: 60-bed pediatric hospital within UW Hospital and Clinics, nationally known for treatment of children’s lung diseases and other pediatric specialties.
- Transplant program: one of the nation’s most comprehensive and successful transplant programs.
1998 Transplants:

- Kidney: 267
- Pancreas: 61
- Heart: 34
- Liver: 73
- Lung: 23
- Small intestine: 1
- Lung/heart and other multiple organ transplants also performed.

- Ophthalmology: leader in eye research, especially in diabetic retinopathy, age-related eye disease, ocular melanoma. Ranked second nationally in federal research support.
- Stroke Center: offers one of the most comprehensive sets of stroke studies in USA, including testing of multiple surgical interventions, advanced diagnostic imaging and medications and therapeutic interventions for acute stroke and its after-effects.

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B) Quality Improvement Department:

B1) Strategic Planning:

Quality management in UWHC begins by its Mission, Vision and Goals, which are very explicit:

Mission

Patient Care: To deliver comprehensive, high-quality health care to patients...
Education: To provide an environment suitable for instructing medical and other health professions students, physicians, nurses, pharmacists...
Research: To sponsor and support research in the delivery of health care and applying the advances in health knowledge...
Outreach/Community Service: To assist health programs and personnel throughout the state and region in the delivery of health care.

Vision

To guide its fulfillment of these missions, UW Hospital and Clinics has adopted the following vision statement: To be Wisconsin's foremost health care provider and employer, serving as a statewide and national leader for patient care, education, research and community service.

Strategic Goals

1. Strengthened Integration. Align the vision, goals and operations of the UW Health organizations.
2. Management of Care. Improve the management of care, focusing on appropriate utilization of clinical resources.
3. Management of Costs. Maintain a strong and competitive financial position through stringent control of operating expenses, prudent capital investment and strengthened fiscal accountability.
4. Continuum of Care. Strengthen and expand the continuum of care, emphasizing development of non-acute care services and tools to manage population health.
5. Network Development. Pursue a multi-faceted network development strategy encompassing primary care, managed care and specialty care packages.
6. Clinical Research. Strengthen capabilities in clinical research through enhanced organization, investigator training and recruitment.
7. Clinical Education. Adapt educational programs to mirror and support changes occurring in health care delivery while promoting new mechanisms for funding this important societal role.
8. Outreach and Community Service. Strengthen community visibility and involvement through a more coordinated, comprehensive outreach and community service program.
9. Communication and Customer Service. Improve communication and service to all customers of UW Health-including patients, referring physicians, employers, insurers, fellow employees and the public at large.

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B2) Plan for Organizational Performance Improvement:
(source: UW Health, Plan Org. Perf. Imp., Internal Doc., UWHC, june 1999, pp 1-16, r10.05).

In order to serve its strategic goals, mission and vision, the UWHC uses a Plan for Organizational Performance Improvement.

The purpose of such quality plan is to assure that health care services delivered to patients are appropriate, efficient, effective, safe, and consistent with professionally recognized standards of care and that the efforts to improve performance are ongoing and integrated throughout the organization. Due to the rapidly changing nature of health care, the plan incorporates Continuous Quality Improvement, Clinical Evaluation and Outcomes Research activities. The organization should be characterized principally by patient focused, provider oriented, no boundary between ‘quality’ and ‘management’ of care, accountability for quality of care, patient satisfaction and resource utilization.

Performance improvement is achieved through the establishment in each department or service by the implementation of a relevant agenda of ongoing performance measures, case reviews, and process improvement projects. Performance improvement is ultimately tied to the fulfillment of the Hospital’s Mission and achievement of its Vision.

Beyond the voluntary hospital accreditation, the quality management method used at UW Health is the continuous improvement of the processes by which services are provided to meet, and exceed the needs and expectations of patients and their families, students, employees and member of the community.

This method is based upon several principles of quality:

- Commitment and involvement on the part of leadership, including the Board, Medical Staff, Administration and Department Managers.
- Most problems and opportunities for improvement are tied to process weaknesses, not to individuals. Therefore, performance is best improved by focusing on systems and processes rather than on individuals.
- Performance improvement must be focused on the patient and coordinated across disciplines and departments. It depends also on information and data which need to be used to confirm the existence of problems, identify opportunities of improvement and evaluate the effectiveness of process improvement. Decisions should be made based on data, not on intuition alone.
- Employees who are directly involved with a process are best qualified to improve it.
- Performance improvement recognizes the need to work in partnership with other components of the care system to assure quality.
- Staff are trained and are competent to serve specific population.

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B3) Performance Improvement implementation:
Several elements are needed for success in Performance Improvement at UW Hospital, like displayed in the cause-effect diagram below (figure 10):

Fig 10: Cause-Effect Diagram of the Performance Improvement Process at UWHC

Culture: The culture of UW Health is one of value and trust for employees, medical staff and students focused care.

Education: all employees, staff and managers need to learn new skills and approaches for stabilizing and improving processes. The Director of Clinical Affairs assures the availability of means by which all hospital members have access to learning about Performance Improvement methods and tools. The Hospital also provides a curriculum of continuing education in quality. Today, the quality trained hospital members are about 400 (10% of the total), and it is considered like well according the means in teaching staff (only 1 person). Very often, a part of trained employees are able to train or to explain quality concepts, methods and tools to their colleagues. This kind of person becomes a natural leader for a team of about 5 to 10 people. Thus, there is a natural amplification of the training given by the teaching staff.

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The one day quality courses provide by the Clinical Affairs Department are listed in the figure 11:

Fig 11: Quality courses at UW Hospital

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Very often, there is a little homework for each course. The role definitions of each actor in the quality team process are the following:

Facilitator:

Characteristics
- Outside the process and/or the department
- Skilled in data-based problem solving
- Knowledgeable about group process
- Skilled communicator
Responsibilities
- Communicator: keeps all areas informed of quality improvement activities
- Champion: helps maintain quality improvement progress and team momentum
- Instructor: instructs in quality improvement process and techniques

Team leader:

Characteristics
- Supervisor or manager in project area
- Expertise in process
- Knowledgeable about process
- Able to leave rank outside meeting room
Responsibilities
- Designs action plan, agendas and team meetings
- Teaches and leads team through process improvement steps
- Help maintain team momentum
- Communicates and coordinates with all affected and involved areas
- Meets regularly with management

Team member:

Characteristics
- Knowledgeable about process
- Desire to be involved
- Willingness to speak up
- Ability to commit time and energy
Responsibilities
- Attend and participate in all meetings
- Gather data
- Analyze root causes
- Participate in presentations
- Recommend solutions
- Track effectiveness of solutions
- Establish on-going monitoring (quality control)

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Leadership and Coordination: the organizational structure of the coordination of performance improvement at UW Health is shown in the figure 12 below, which illustrates the linkages between the various entities associated with improving organizational performance:

Fig 12: Quality Committees at UWHC

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Committee on Performance Improvement, Risk Management and Safety: the Chairperson of the UWHC appoints 2 Board members as liaison with this Committee which receives and reviews detailed performance improvement, risk management and safety reports. If there is an issue that requires Board action, the liaisons present the issue to the Board, otherwise, they report to Board only the broad outlines of activities to assure to the Board that the process is functioning as approved.

Performance Improvement Coordinating Committee (PICC): It establishes and maintains the vision and goals for quality in the Medical Center; integrates about 20 members like medical staff, nursing, other healthcare providers, hospital administration and members of quality improvement department and clinical affairs.

Quality Evaluation & Review Committee (QERC): It is responsible for oversight of departmental performance assessment and improvement activities which are accomplished by annual departmental committee reporting to QERC. QERC is also responsible for measurement and ensuring compliance with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)³³ standards. The JCAHO accredits health organizations every 3 years. QERC includes about 30 members from each medical department which has its own quality review sub-committee with a meeting every week.

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B4) Improvement process and Quality Improvement Department:

The Quality Improvement Department supports all quality committees in hospital, plans and manages quality actions and training, looks after the quality indicators and reports all interesting information to the Physician in Chief. It also prepares the renewing of the hospital accreditation and develops the concrete quality actions following the Institutional priorities and strategies. UW Health uses approaches for improvement which include:

- Individual traditional quality assessment activities and peer review
- Structured method based on the seven step process
- Quality control

The Plan - Do - Check - Act process may entail seven steps:

Plan:

Step 1: Identify and analyze the critical process, estimate the gap in quality
- Identify the process
- Flowchart the process
- Identify the customer
- Identify the gap in quality
- Identify team members
- Train team members

Step 2: Master the data, using it, develop a thorough understanding of the process, establish specific quality indicator
- Macro-process flowchart
- Validate customer requirements
- Establish quality indicators
- Complete data stratification

Step 3: Probe for the root causes, analyze factors contributing to problems in the process, search for, identify and verify actionable root causes
- Determine root causes
- Verify root causes

Do:

Step 4: Review and develop solutions which address the verified root causes of the gap of quality, determine that the solutions are cost effective and that they meet customer requirements. Develop an action plan.
- Select solutions addressing root causes
- Verify cost-effectiveness of solutions
- Verify that solutions meet customer needs
- Develop an action plan

Check:

Step 5: Observe the change. Solutions are implemented, as pilots if possible, and the results of the change are measured. Data should demonstrate a closing of quality gap and elimination of root causes.
- Data demonstrates improvement
- Root causes reduced or eliminated
- Contributes to hospital goals

Act:

Step 6: Verify fit in the workplace. Successful solutions are identified for standardization, key indicators and methods are developed and automation of ongoing monitors is investigated
- Successful solutions identified for standardization
- Standard processes/procedures developed and tested
- Key indicators developed
- Automation of ongoing monitors investigated
- Action plan for continuous monitoring developed
- Plan implemented and communicated

Step 7: Ensure the future, generalize improvements to other areas, investigate future improvements, share findings, celebrate achievements
- Explore generalization to other areas
- Additional improvements investigated
- Findings shared

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The performance measurement is often the most difficult to do because the nature itself of the direct or indirect indicators. The following criteria help to ensure that the data collected are appropriate for monitoring performance :

- the measure can identify the events it was intended to identify
- the measure has a documented numerator and a description of the population to which the measure is applicable
- the measure has defined data elements and allowable values
- the measure can detect changes in performance over time
- the measure allows for comparison over time within the hospital, or between it and the other health entities
- the data intended for collection are available
- results can be reported in a way that is useful to the hospital and other interested stakeholders

According the Directors of Quality Improvement Department and Clinical Affairs, the three success keys of performance improvement in an organization are:

- Strong, permanent and efficient training of all hospital members, at all levels
- True and strong commitment and involvement at the top management staff
- Audacity, still audacity and always audacity for the quality managers, teams and members involved by continuous improvement.

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C) Medical Physics Department³⁴:

The word Medical Physicists groups together physicists who work on radiotherapy, X Ray radiodiagnostic, US diagnostic and Magnetic Resonance Imaging (which is a little bit shared with biomedical engineers) In the USA, medical physicists are about 3000, in Wisconsin about 70 and in the University Hospital of Madison, they are about 12.

The Radiotherapy Service uses some specific medical apparatus like 1 CT Scanner (Siemens), 4 Linear Accelerators (Varian), 1 simulator (Varian) 1 ultrasound unit (Siemens). They also make considerable use of the imaging modalities in the Radiology Department. There are 11 therapists and among them 4 are trained to do daily assurance quality procedures on linear accelerator and simulator. Four are also trained to perform the quality assurance on the CT unit.

- daily: 20 mn to check general parameters on a unit,
- weekly: 90 mn for a more thorough check by the physics staff, that rotates through a different set of checks over a month.

A Radiation Protection Code has been established by the State of Wisconsin and is used to plan and manage the minimum about safety and quality procedures (Wisconsin Administrative Code, Rules of State Board of Health, Radiation Protection Code, Chapter H 57, January 1966). For Curietherapy and Cobaltotherapy, there are also laws which impose the responsibility for an institution to do minimal quality and safety procedures (www.nrc.gov, Title 10, Part 35). For Linear Accelerators, some new technical rules are coming soon from the State of Wisconsin.

The Quality Management take several forms in the Radiotherapy Service of Medical Physics Department. The major quality checks of units and medical procedures are:

2 times per year:
- Control of measure and test instrumentation ( Thermoluminescent Light Detection...) used to control patient radiation.
Each year:
- Inspection by the University Safety Department to measure and control the radiation dose inside and outside the service for workers, employees and patients.
- Inspection by the Nuclear Regulatory Inspection (Federal Organization) on the good professional practices and procedures used by the Department.
Each 3 years:
- Visit by the Quality Review Committee of the Hospital in order to be ready for the renewing of the Accreditation for all the Hospital. The Join Commission on Accreditation on Healthcare Organizations (http://www.jcaho.org) comes every three years. The Quality Review Committee of the department meets every week, and has a representative in the hospital Quality Evaluation & Review Committee.

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In the Radiological Physics Services, the quality management is permanent, both on the technical control of the X ray devices (about 80), and on the organization improvement where TQM is employed.

There are 2 quality committees for the Radiological Services:

- Quality Assurance Committee which focuses about technical quality of devices in order to do the best diagnostic
- Quality Improvement Committee which is focused on the ability of the organization to satisfy the patient and to improve the quality process.

For the first preceding point, 2 standards give the minimal rules to be observed:

- Code of Federal Regulations (1994): X ray => Chapter 21 CFR part 1020
- Wisconsin Administration Code (1982): Radiation Protection Code HSS 157

The X ray Quality Assurance Manager has an office into the Radiodiagnostic Service and is permanently helped by 2 medical physics students to plan, do and check the different procedures associated to the technical control of the X ray devices. Some imaging phantoms have been developed by the QA manager himself who also uses classical testing instrumentation. It is kept track of all quality records, but at the moment there is still no publication about the profitability of the quality check by internal service in X ray upon the quality of the medical diagnostic. It seems obvious that it is necessary and efficient, but some quantitative proofs could be very useful for other radiological services which plan to develop such approach.

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D) Clinical Engineering Department:

The Clinical Engineering Department at the University of Wisconsin Hospitals & Clinics (UWHC) has one Clinical Engineer has 7 biomedical technicians. It is integrated into the Plant Engineering Department which is composed of 80 people (figure 13).

Fig 13: UW Hospital Plant Engineering Department Organization Chart

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The only one Clinical Engineer who is at the head of the CE Department is helped by another one from the University Healthcare Consortium (UHC)³⁵ by contract with UWHC. This kind of partnership is often used in US hospitals in order to compensate the lack of people.

The shops where work biomedical technicians are very small and it is obvious they need more place to correctly perform their job.

The CE Department has been accredited by JCAHO in fall 1999. A helpful guide³⁶ is edited by JCAHO in order to prepare the accreditation where the chapter 8 is specific to the Medical Equipment Management.

About requirements and recommendations used daily by the Clinical Engineering Department, most of them come from AAMI³⁷ , the biggest biomedical professional association in the USA. AAMI provides professional recommendations or requirements very useful for clinical engineers and biomedical technicians.

Other sources which provide official, national or international, standards in clinical engineering are :

- American National Standards Institute (ANSI)³⁸, equivalent to the French AFNOR³⁹
- National Fire Protection Association (NFPA)⁴⁰ which provides codes and standards about health care facilities, electrical equipment maintenance and electrical safety.

According to the Director of the clinical engineering department, the daily use of such codes and standards from these organizations improves the facility to be accredited.

The ISO 9000 Certification is not an objective neither a priority in the US clinical engineering departments. Only few of them are certified, even if the advantages to have a more rigorous organization and an efficient documentary system are recognized.

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My professionnal project is about implementing quality management methods into public organizations like University, Research Laboratory and Hospital.

All I have seen during my stay at UW-Madison is available to implement in the French context and especially Strategic Planning and Continuous Improvement which are soft and smooth methodologies to promote quality culture.

Quality is a challenge, and not a battle ! That is why it is better to begin with voluntary teams into public organization, the essential thing being to give at each people the wish to develop quality approach, methods and tools in their daily work, because they will know working environment will be more comfortable and problems easier to resolve without psychological strain or bad feelings.

This chapter presents the impacts of Strategic Planning and Continuous Improvement on proposals to design and manage the two objectives of my professional project : Quality in Research and Quality in Hospitals.

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A) Quality in Research at UTC:

The project « Quality in Research at UTC » is very important because it will be the first time, that quality management principles will be applied at Compiègne University. The challenge will be to succeed with this first experience in order to create a good feeling about quality.

According to the Director of the Research Department, quality management methods and especially continuous improvement will be tested with a voluntary scientific team⁴¹ .

According to the strategic planning model, Mission, Vision and Priority for the Research Department can be given like possible examples (figure 14). Of course, these proposals still need to be discussed and validated, but a good, reasonable and motivating priority could be to reach the Excellence in Research.

To reach the Excellence in Research, it is necessary to have excellent researchers with excellent organization. The project focuses about this second point which can be very often widely improved. That is the reason, one of the strategic directions is to implement Quality Management methods and tools in research organization.

Fig 14: Example of the Strategic Planning applied to the Research Department at UTC

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This involves three measurable four-year goals between 2000 and 2004:

- The first one is to test the real benefits of continuous improvement with a voluntary research team.
- After that, to evaluate the results of the improvement process, to understand the gap between them and the attempts, to improve the processes and to standardize solutions which are really benefit and progress for the research team.
- The third goal is to communicate about clear, real and proved gains and advantages in order to lead other scientific teams to test and use quality management tools and then diffuse quality into research organization. This way will be not very easy to manage, that is the reason, it is necessary to choose very carefully the success criteria for this first quality experience and not to be too ambitious in a first time.

Concerning the voluntary scientific team, its research is in majority applied with a lot of industrial contracts and funding. So, they develop new processes for the environment, agronomic, industrial food and powder technology areas.

They have numerous technical experimentation sites, inside and outside the University. That is why, they need to better control the safety of the experiments (figure 15).

To help researchers, they also use a lot of engineering students who work to improve for example a part of the experiments. That is why, they would like to better manage the important turn-over in order to be secure and efficient with new students.

Fig 15: Quality action plan for the voluntary research team

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The team has about 30 permanent researchers and 15 scientific engineers or technicians. The organization is classic with several thematic groups, an administrative staff, a scientific council and a leader. This team is also recognized by the French National Council of Scientific Research, that means the quality level of its research is well recognized and approved.

In order to keep the funding level and improve it, in majority from private and international companies, the team leader would like to use the same quality culture to give them confidence in his capacity to understand, to define and to find effective solutions to their industrial problems. Very often these companies use total quality management principles, can be also ISO 9000⁴² certified or have some accredited EN 45000⁴³ laboratories like sub-contractors.

But it is no question to spent a lot of time or money for a quality development, especially when there is no proof it will be really profitable. That is the reason it will be applied an evolutionary process and not a revolutionary one.

The general methodology I will propose to use is the 7 step process of problem resolution which provides a continuous improvement (figure 16). According to the Director of the Office of Quality Improvement at UW-Madison, it is really the more efficient way to begin and control a quality development, because it focuses directly on real problems and also their operational solutions. This approach provides the guarantee to optimally spend time, energy and money.

Fig 16: Seven step process of problem resolution providing continuous improvement

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Certainly, some members of the research team could have some natural reluctance about the change and it is also necessary to be very careful not to spend too much time in meetings.

For that I propose to apply the advice given by Kathleen Paris from OQI: fewer meetings but more accomplished !..[Paris, 1999a]. The method is simple:

- first to define a clear understanding of purpose and also outcomes which are attempted,
- second to decide whether a meeting is really required (there is not always evidence or necessity for that)
- third to find the best person to conduct the meeting (it is not necessary always the chief especially when he is strongly concerned),
- fourth to define and timetable the quickest agenda with the aim of the meeting at the top and the use of verbs in items to avoid vague proposals and fuzzy actions,
- fifth to end the meeting with a project timeline where it is written what it should be done, by whom and when.

In order to be able to reach the two other goals concerning the Strategic Planning for the Research Department (to evaluate results and standardize solutions ; to diffuse quality principles at all other voluntary research team), I suggest to plan to be able to improve the process of the improvement process implemented in the research team.

For that, the use of the PDCA cycle is the best way to be credible, to know what it will be really asked to do, to improve the process and to be able to widely diffuse the method after this first experience (figure 17). When it will be necessary to check the results of the improvement process, a possible and useful indicator could be the percentage of resolved problems versus the attempts and the time needed for that [Paris, 2000]

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Fig 17: Continuous Improvement of the Improvement Process

The first step of the project "Quality in Research" is planned on two years from 2000 up to 2002. After that and if the results are real, proved, profitable and enjoyed versus the energy, time and money spent for that, then the Research Department will develop a « Quality Resource Center » in order to:

- capitalize the first progress in quality management,
- diffuse the methodology at all other voluntary university teams and maybe,
- develop some original concepts, methods and tools especially adapted to the scientific research and higher engineering education. For example, OQI at UW-Madison has created an « Accelerated Improvement Process » from its own experience, which permits to divide by 2 to 5 the time needed to resolve a problem and implement new solutions [Cotter, 1999]. It is a concentrated version of the 7 step process seen before.

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B) Quality in Hospitals:

The second objective of my professional project is about "Quality in Hospitals". If the strategic planning model is applied on this field, global Mission, Vision and Priority available for all French hospitals can be defined (figure 18). The last point, the priority to obtain the French accreditation comes from the new French law⁴⁴ which imposes all French hospitals, public and private, to be accredited before March 2001.

Because Compiègne University teaches Clinical and Biomedical Engineering since its creation, and has now taught more than 80% of the French hospital clinical engineers, there is a particular attention from its managers, especially those in continuing education, to respond to this new hospital market demand.

Fig 18: Example of Strategic Planning applied to French Hospitals

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The French hospital accreditation is obligatory, on the contrary US and Canadian accreditation are voluntary. But both are at the origin of the French referential, that is why it contains a lot of total quality management philosophy. In France, Hospital Accreditation is a subject with an extreme political sensitivity. Indeed, the President of the Public Hospital Board is the mayor of the town and the hospital is very often the first or the second employer of the area. So, it is politically strategic to have a good hospital, and all problems like strikes or closing of medical service are not welcome ! That is the reason, accreditation for public hospital is a political deal, and for private hospital it could be the only way to survive ! This explains why, all hospitals in France are rushing to obtain accreditation before the deadline.

Like in all old and public organizations, problems to implement quality management in hospitals are numerous:
First the old oral culture is shocked by the need to write and trace all processes with the quality management methods. There is already a feeling of lack of confidence about the managers who want to implement such methods and already the beginning of a social strain. This problem of quality in public sector is the research area of some researchers at CQPI, UW-Madison, and it could be interesting to exchange data and experiences in the future.

Second, about the lack of Directors’ commitment, we are helped in France by the Health Authorities and all upper managers, directors and CEOs have to take into account the requirements of the accreditation. This one contains strong inducements to self-evaluation and quality management at all levels in the organization. Because there is a lack of quality knowledge and operational know-how, the Directors’ staff must be urgently educated. It is now a one-year action for numerous hospitals, and certainly still for several years !.. At the moment, quality training in hospital is done by consultants and there is no, or very few, specific quality courses for healthcare managers. Some Directors or managers who are in charge of the accreditation, attend and try to complete efficient quality course in Universities or in Higher Education Colleges, unfortunately very often focused on industrial field.

That is why the project "Quality Course" is focused especially on hospitals in order to train efficiently their quality managers and all other employees strongly concerned by quality.

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Fig 19: Strategic Planning applied to the Quality Course Project

Like shown in figure 19, the project replies to a demand which comes from the strategic planning of hospitals. But it is also possible to use the strategic planning model for the project itself ! It is interesting to see the effect « Russian Doll » of this methodology. In fact, each action, each activity could be managed by a strategic planning. Moreover, with this model, we can observe the linkage between the potential customer’s needs and the educational service provided. The inputs of the project Mission are the customer’s needs. One of the outputs (measurable 3-year goals) should be obligatory the satisfaction of these customer’s needs.

For the educational project, the Mission is to train intensively hospital CEOs, Directors and Quality Managers about: Concepts of Quality in Healthcare, Methods and Tools of Quality Management and Specificity of Hospital Accreditation.


To balance the budget, the course should be attractive enough in order to have each year at least 20 to 25 students. So, the Vision "to be the most attractive" involves two priorities:

- First to be efficient, modern and credible because a lot of very professional consultants are on the market,
- Second to develop an educational network, a partnership with other universities or schools because Compiègne University is specialized in engineering and doesn’t have all resources for such educational program.

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To be efficient, modern and credible, it could be very helpful to use the continuous improvement methodology. That means to use the PDCA cycle at each step of the program, Design, Marketing and so on, but also on the entire educational program itself (figure 20).

Fig 20: Continuous Improvement applied to the Quality Course process

The management of such process will be a good way to be credible because the managers themselves will know what they will teach and efficient because they could control the entire process of the educational program and it will be easier to improve it and to be ready at all market change.

For that it is necessary to design and express clearly and accurately what it should be done in each step of the process and, maybe more difficult, what are the inputs and outputs of each sub-process. I have prepared a very detailed proposal about this management process which will be discussed between June and August 2000 and maybe approved by all partners.

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At the moment, three partners are in the educational network, each being complementary of the others:

ENSP is the only French National Public Health Higher Education School which teaches all public hospital directors in France. This school depends on Health Ministry and has a very great impact on new and former hospital managers.

Montreal University because it is a French speaking area and the origin of the French accreditation comes in part from the Canadian model. There is also a great experience and expertise about quality in healthcare.

UTC, because its long teaching experience in Quality for industry and Clinical Engineering and also there is a long know-how on distance learning methodology.

The course is designed to be recognized by both Canadian and French Educational Authorities in order to be useful for the professional evolution of the applicants. The majority of applicants will be professional hospital managers certainly in charge of great responsibilities, most of them could be French and it is planned to have 20% of Canadian or foreigner applicants. The course will be provided for a third part like a classic training in each of the three partners, and the other two third part by distance learning.

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Conclusion

In conclusion, Strategic Planning and Continuous Improvement are very attractive methodologies and could certainly optimize dramatically daily work of everybody.

Very often people have to do a lot of things, to make a lot of decisions without the comprehension of the origins of the problem, or the impact of their own actions on the others into the organization. They have no time, they are so busy and they work 12 hours a day. It is obviously a wrong way, because it is impossible to continue to control a more and more complex system or organization like that. And this fact is increasing each day !

A good manager has to do the efficient things at the good moment at the right place with the right people. For that, it is necessary to know exactly where, when and how to focus, according to the organization, department or service : Strategic Planning is really helpful for that ! People have also to daily minimize the gap between their results and the attempts of their processes: Continuous Improvement is the right tool for that ! Both could create a more comfortable working environment.

I saw at Madison, the real effects of total quality management philosophy on big organizations in the same field than those I work in France: University and Hospitals. I really think it is possible to implement such methods, because there is nothing “extraterrestrial” but on the contrary a lot of useful and efficient kind of tools and methods to resolve problems, to find pragmatic solutions and to be sure they are always working in the future.

The most important success key is the commitment of the upper managers, and for that I hope to be convincing, pragmatic and charimastic enough in order to give them confidence about the strategy and the attempted results.

I don’t know if the quality of life at Madison comes from the quality culture of people, or the inverse, but the quality of my stay in the Wisconsin, and particularly at the University has created on me a very good feeling to continue my efforts to develop and promote quality management, simply and efficiently. “Constancy of the Purpose !” Deming said...

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Appendix

Appendix A:

OQI : Office for Quality Improvement

(Source: http://www.wiscinfo.wisc.edu/improve/)
University of Wisconsin- Madison, Bascom Hall, 500 Lincoln Drive, Madison, Wl 53706-1380-USA
tel: (608)262-6843, fax: (608)263-2081, email:quality@mail.bascom.wisc.odu.

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Appendix B:

CQPI : Center for Quality & Productivity Improvement

(Source: http://www.engr.wisc.edu/centers/cqpi/)
10 Walnut Street, 575 WARF Building, Madison, Wisconsin 53705
Telephone: (608) 263-2520 Fax: (608) 263-1425 E-mail: quality@engr.wisc.edu

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(read and see : Deming WE,1989, Out of the Crisis, Ed. Massachusetts Institute of Technology, Center for Advanced Engineering Study, Seventh Printing, April, p 507, ISBN 0-911379-01-0
Deming WE, 1994, The new economics, for Industry, Government, Education, Ed. Massachusetts Institute of Technology, Center for Advanced Engineering Study, Second Edition)

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Seven Management (New) Tools
Hoshin Overview & History
Juran

DEMING's websites:

Bay Area Deming Users Group
British Deming Association
Dallas Study Group
Deming Cooperative
Deming Electronic Network Web Site
French Deming Association
John Hunter's Deming links
Indiana Quality, Productivity, Involvement Council
Madison Area Quality Improvement Network
MIT/CAES Deming site
Ohio Quality and Productivity Forum
Russian Deming Association
The W. Edwards Deming Institute

KAIZEN websites:

Kaizen Institute
Kaizen from the Persp. of Comp. Advantage
Quality Digest

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Quality, Higher Education and Research Web Sites

UW-Madison
UW-Hospitals & Clinics
UW-Office of Quality Improvement
UW-Center for Qual. & Produc. Improvement
UW-Research & Sponsored Programs
UW-Research Park
UW-WARF (Alumni Foundation)
UW-University-Industry Relations
UW-Teaching Academy
UW-Creat. Coll. Acad. Envir. (CCAE)
UW-Graduate School
American Association of Higher Education
National Science Foundation
WebCT

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Quality, Health, Biomedical Clinical & Engineering Web Sites

Association for the Advancement of Medical Instrumentation (AAMI)
American Association of Physicists in Medicine (AAPM)
American College of Clinical Engineering (ACCE)
American College of Medical Physics (ACMP)
American College of Radiology (ACR)
American National Standards Institute (ANSI)
American Society for Healthcare Engineering (ASHE)
American Society for Quality (ASQ)
Baldrige Criteria for Performance Excellence
Biomedical Engineering Department (BME UW Madison)
Emergency Care Research Institute (ECRI)
Engineering in Medicine and Biology Society (EMBS)
International Federation for Medical and Biological Engineering (IFMBE)
International Organization for Medical Physics (IOMP)
International Society for Measurement & Control (ISA)
International Society for Quality in Healthcare (ISQua)
Intern. Union for Physical and Eng. Sciences in Medicine (IUPESM)
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
National Fire Protection Association (NFPA)
National Institutes of Health (NIH)
National Institute of Standards and Technology (NIST)
Nuclear Regulatory Commission (NRC)
University HealthSystem Consortium (UHC)

French websites :
Agence Nationale d’Accréditation et d’Evaluation en Santé (ANAES)
Association Française des Ingénieurs Biomédicaux (AFIB)
Association des Agents de Maintenance Biomédicale (AAMB)
Portail Biomédical Hospitalier

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¹ Ordonancy of 24 April1996.

² http://www.utc.fr/~farges/Qualite/Q_formation/Q_formation.html

³ UE common position of 24 September1998 (Farnleitner, 98/561/EC)

⁴ http://www.wisc.edu/

⁵ http://www.greatermadisonchamber.com/move/pop2.htm

⁶ http://www.entrepreneur.com

⁷ http://www.wiscinfo.wisc.edu/improve/

⁸ http://www.wiscinfo.wisc.edu/improve/

⁹ see Appendix A

¹⁰ http://www.wiscinfo.wisc.edu/improve/who/newsletter.html

¹¹ see Appendix B

¹² Wisconsin Alumni Research Foundation : http://www.wisc.edu/warf/

¹³ http://www.engr.wisc.edu/centers/cqpi/short_list.htm

¹⁴ http://www.engr.wisc.edu/consortia/qasrc/

¹⁵ http://www.maqin.org/

¹⁶ http://wiscinfo.doit.wisc.edu/teaching-academy/

¹⁷ http://wiscinfo.doit.wisc.edu/teaching-academy/beingnew.html

¹⁸ http://wiscinfo.doit.wisc.edu/teaching-academy/itwhitepaper.html

¹⁹ http://www.aahe.org/

²⁰ http://www.wisc.edu/MOO/

²¹ http://wiscinfo.doit.wisc.edu/teaching-academy/teaching_ideas_network.html

²² http://www.wisc.edu/ccae/

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²³ http://www.wisc.edu/ccae/ccle/index.html

²⁴ http://www.wisc.edu/ccae/MOO/

²⁵ http://www.rsp.wisc.edu/

²⁶ http://www.rsp.wisc.edu/chap2/rr32.html

²⁷ http://www.rsp.wisc.edu/services/guides.html

²⁸ http://www.engr.wisc.edu/bme/

²⁹ http://www.whitaker.org/

³⁰ http://www.cs.virginia.edu/research/sponsors.html#foundations

³¹ http://www.cs.virginia.edu/~robins/

³² http://www.uwhospital.hosp.wisc.edu/

³³ http://www.jcaho.org

³⁴ http://kermaosf.medphysics.wisc.edu/

³⁵ http://www.uhc.edu

³⁶ JCAHO, 1998, The Environment of Care® Handbook, Ed JCAHO, 129 pages, ISBN: 0-86688-589-7

³⁷ http://www.aami.org/

³⁸ http://www.ansi.org/

³⁹ http://www.afnor.fr

⁴⁰ http://www.nfpa.org

⁴¹ Grant asked to the French Research Ministry (April 2000)

⁴² International standards about Quality System (version 1994 : 9001, 9002, 9003 ; version 2000 : 9001)

⁴³ European standards series about accreditation of trial and measure laboratories

⁴⁴ Ordonancy of April, 24, 1996

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