Consultancy
Op Dieet Voor Een Gezond Systeem Succesvol Afslanken Van Een Omvangrijk KwaliteitssysteemHow can the number of documents be reduced in a quality system that could truly be described as a ‘heavyweight’? At the end of last year, Stichting Sutfene decided to drastically cut back on more than 1,000 quality documents, ranging from policy papers to specific checklists. The approach proved decisive in achieving a successful outcome: the number of documents was halved.
Inspired by principles from both quality management and process management, a project was launched to tackle the ‘paper flood’. The result was a 50% reduction in the number of existing documents within the quality system, while maintaining risk coverage and improving both quality and user-friendliness. This article explains how this ‘diet’ was designed, covering the starting point of the initiative, the approach taken and the key success factors.
Time is ripe for change
Stichting Sutfene, active in home care, residential care, nursing and treatment, developed a new vision of care in 2009 and redesigned all primary and supporting processes from a process-oriented perspective. By making clear agreements on reducing errors and improving customer satisfaction, a solid foundation for quality was established.
After implementing the new processes, it became clear that the quality system itself also required renewal. Due to the volume, overlap and unclear status of the existing documents, the system was increasingly described as ‘unworkable’. Under the title ‘Operation Document Rationalisation’, a project was launched together with the consultancy firm BPM Consult to clean up the large number of documents. The aim was to align with the renewed organisation and to create a leaner, well-structured quality system.
Phased approach
To streamline the overly complex quality system, the first step was to gain insight into the range of quality documents in use, followed by an assessment of how better control could be achieved over their volume.
- Step one is simply to collect all the documents that exist within the organisation. This means not only what can be found in the quality manual, but also everything that employees uncover from their own PCs, drawers and cupboards. It quickly becomes clear that, in terms of outdated versions and local solutions, a second ‘reality’ of quality documentation exists. Problems are often solved locally in individual ways, even though they could be addressed centrally.
- Step two is to assign all documents to the primary and supporting processes. Determine where in the processes the various documents are used in order to build a clear picture of where quality plays an important role and whether it is already embedded in the existing process agreements. This gives you a clear overview of what you have.
- Step three involves working with managers, team leaders and coordinators to determine what actions are needed for each document in order to achieve a leaner, but above all better, quality system. Assign one of the following actions to each document: retain, remove, split, integrate, simplify or create a new document. The working method used at Sutfene also proved important: all documents were printed and analysed during a two-day workshop by a cross-section of managers, team leaders and coordinators. During the workshop, it was recorded in each document what needed to be changed.
- Step four focuses on clustering documents as much as possible by theme, such as intake, changes, BOPZ legislation and fall prevention. The reason for this is that the same procedure can often be found in different variations across different, but similar, processes. This leads to significant overlap, which does not benefit the clarity and manageability of the quality system. For example, separate fall prevention procedures had been developed by both nursing and care teams, even though the content was almost identical. A designated individual or team is then made responsible for further developing all quality documents within a specific theme.
- In step five, the identified themes are redesigned by the assigned owner or owners, using the insights from step two and the actions defined in step three. Standard formats, including version control, are used in this process.
- The sixth and final step involves consolidating all the developed themes into a coherent system and making agreements for the systematic evaluation and refinement of the new content. The result is a significantly streamlined and clearly structured system.
Behind these steps lies an underlying philosophy built on three key success factors, grounded in principles of quality and process management.
Success factor 1 – Only formalise what is necessary
Quality assurance does not automatically mean that everything has to be documented. There are at least three reasons why this is not always necessary.
First, the quality system can quickly become a large, unwieldy and complex instrument that is difficult to work with. Second, there is the professionalism of employees to consider. Where quality is already assured through solid training and experience of employees or teams, additional formal documentation is often unnecessary and can feel overbearing. Third, it helps to avoid overlap with agreements that have already been captured in the organisation’s processes.
After all, well-designed process descriptions already ensure the integrated control of groups of activities and coordination between roles. The quality system should only provide support where it adds real value.
Success factor 2 – Ensuring clarity and simplicity in how quality is embedded
If the quality system is clear and well-structured, employees will find it easier to use. During the analysis of all identified quality documents in this project, several causes of complexity were identified. The first cause is content overlap, where large sections are repeatedly copied across documents. A second cause, as one manager put it, is the presence of a lot of ‘prose’, such as background information on the origins of the BOPZ Act in 1992 as a continuation of earlier legislation. Interesting, but not necessary. A third cause is that different parties perform the same activities with associated control mechanisms but describe them in their own variations. Finally, outdated versions or draft documents often remain in circulation.
To reduce unnecessary text and overlap, a documentation pyramid was used. This pyramid is based on the document hierarchy from ISO standards and provides guidance when analysing each individual document within the quality system. For every element of each identified document, it was determined whether the content belonged in a policy document, process diagram, procedure, protocol, work instruction or checklist. In doing so, a careful assessment was made of whether the content added value, and clear choices were made regarding distinctions between locations and target groups. Differentiation is only applied where it is genuinely necessary, preventing departments from creating local solutions that could instead be addressed in an integrated way.
Success factor 3 – Quality is everyone’s responsibility
During the project, it became clear that quality does not belong to the quality manager, but to all employees. This reflects the ideal, as described by Juran, of delegating responsibility for quality as much as possible to employees on the shop floor. By leveraging the training, experience and creativity of employees, the greatest opportunities for building an effective quality system are realised.
Employees must therefore be fully involved in, and take responsibility for, quality management. However, this responsibility cannot be delegated until decisions and actions are clearly defined. At Sutfene, it would have been impossible for the quality manager alone to determine, within a reasonable timeframe, the status of all 1,000 documents and how they interrelate.
For this reason, during a two-day workshop, the organisation called upon those who are responsible for quality in their day-to-day work. With their input, the flood of documents was broken down into manageable parts, grouped by theme, each with corresponding improvement actions. This then enabled the responsible individual or team to take ownership and move forward.
In summary
A combination of principles from quality and process management can reduce an unwieldy quality system by half. Describe only what is truly necessary, document it just once, capture it at the right level, make full use of the creativity and experience of employees, and discard what is no longer needed. Together, this forms a successful ‘diet’ for achieving a lean quality system.
