Healthcare optimization and its effects on patients

This came from someone who read our recent post on healthcare improvement:

I would like to talk about a recent experience I had at a doctor’s office. Given my medical history, the experience might not be relatable to everyone but I think it highlights an important problem in the area of medical process improvement, where offices are adopting new Standard Operating Procedures to streamline patient visits, as a local improvement without seeing the big picture or global improvement.

To start, it’s important to note that I have a long history with eye doctors and have spent my whole life in the same medical system and hospital, and I have a medical record that could rival Proust’s In Search of Lost Time as a blunt weapon.  Like any experienced patient, I know the procedure for checkups and I know how my eyes should test.

On this visit, I made it quickly from the waiting room to the exam room (an area this hospital has made incredible strides in over the past twenty years) and soon my exam was underway.  The technician measured my eyesight with a multi-line letter chart and then took my eye pressure using a Tono-pen.  Both of my readings were off.

The multi-line letter chart helps prevent cheating through memorization but it makes it much harder to focus on any one line.  Tono-pens are used because they save time over traditional Goldmann tonometers (the little blue cones they press into your eyeball) but they are both less accurate and less precise. We’ll get back to the time savings in a minute.

My vision was measured at 20/30, acceptable for many people and good for others. But with my glasses, 20/15 is the norm and 20/20 is what I have on an off-day when I’m tired.  It’s not a big delta though and it can vary with things as simple as room dryness or the cleanliness of my glasses, so I was a bit annoyed with the result but not yet concerned. Then came the Tono-pen.
 
Tono-pens are a small handheld device for measuring intraocular pressure and they’re a godsend for measuring small children and patients who can’t sit still.  Unfortunately, I’m not one of them and given my eyes’ history, I have a very precise range of what my eye pressures should be. This particular visit, the pressure in both eyes was abnormally high by more than five; the right eye’s being nearly double its normal value and a possible signal that something might be wrong.  The technician’s response was to move me back into a waiting room while my eyes dilated, and advance to her next patient.

All of this was done in a matter of minutes and her efficiency was through the roof!  By basic metrics, she did her job swiftly and followed exact protocol for processing patients.  After all, it’s not her fault my eyes had subpar measurements; the doctor would just have to treat it.

When my doctor arrived, she began a more thorough investigation of my eyes. Her conclusion was that everything looked great.  All of the parts in every sector had maintained their shape and size from the last visit, and there wasn’t a hint of inflammation.  Still slightly worried about the high pressures, I asked if she could re-measure them and she obliged, this time using the gold standard Goldmann tonometer (photo below). This time, everything was normal.

The point of this writing is not to call attention to a single technician, because she did exactly as she was trained.  It is rather to show what generic service can miss and how it could be better.

Upon seeing and hearing that my eye pressures were out of line, the technician should’ve conducted a second test, possibly using the more accurate and precise equipment, and compared it to my historical figures. The problem with this is that it would’ve cost her time, and being in a low level position, she doesn’t have the clout to shrug off time requirements and quotas.

Now why is it a problem if everyone in a medical office tries to work as quickly as possible? 

Mistakes and malpractice aside, it misses the big picture.  The primary bottleneck in a doctor’s office is the doctor herself.  They are in least supply, have the busiest schedules and are almost always the reason you’re processed in a timely or slow manner; the rest of the system adjusts around them.

In this case, spending an extra three to five minutes during the technician’s stage would not have delayed my consultation or departure at all, since I still had to wait another 5+ minutes for my eyes to dilate and another 5+ after that for the doctor to become available.  The same goes for the next patient she had to visit.  If the doctor can only see 5 patients per hour and technicians prepare 10 patients per hour, the clinic will still only fully process 5 patients per hour.  The system can move no faster than the slowest link.

So not only did the time saving measures before the doctor’s stage provide no temporal benefits but in the end, the less precise device actually cost the clinic time it was meant to save.  You see, the doctor spent additional time conducting a re-measurement of my eye pressure that actually could’ve taken place twenty minutes prior when there was a buffer zone.  Reducing time during the technician’s stage meant overloading the doctor’s stage and the end result was an increase in the total time for processing.  As you can imagine, this sort of thing gets compounded with every patient.

In the late Eli Goldratt’s Theory of Constraints, it was recommended improvements to throughput must come by way of removing all unnecessary loads from the bottleneck. At a clinic, this means that anything that can be done by a technician should be done with the precision and accuracy that a doctor requires so that they do not have to repeat testing. By increasing the attention to detail of technicians, it may be possible to reduce the overall load on the doctor, thus speeding up the entire system.  This could add up to significant savings, especially in these times of concern for reducing healthcare costs for both hospitals and patients.

What ever happened to customer service?

It seems these days that customer service has gone to the dogs. It used to be we gave our best customers our best service, especially in this service economy! Here are some of my recent experiences.

Case #1
At a national chain restaurant, the guest check holder (the leatherette bill holder the waitperson brings to your table) was redesigned. Instead of the conventional, little clear plastic pocket that was the perfect size to hold a credit card, their new design has a simple slit that is cut directly on the holder lining.

Because there is no pocket seam to hold the card securely in place anymore, once you insert the credit card into the slit, gravity works to slip right down to the bottom of the 10" deep holder, unbeknown to the customer.

When my waitress brought my credit card slip to sign, the card was nowhere to be seen. After a frantic search of the floor around the table, the card was found stuck inside the lining of the folder where it had slipped down to the bottom. It had a friend, too – another card lost by a previous guest over one week prior! The waitperson's response – "Oh that happens all the time." Well, if it happened more than once, why didn't they fix the problem?

Case #2
The new US healthcare laws require that children over 26 have their own health insurance. After transferring our son to his own insurance plan, he enrolled in automatic-pay from the bank account. The first monthly payment was deducted properly, but not the second. After several long phone calls, it turns out the second payment was deducted from someone else's bank in error. How could that be, since it's all done by computer, right?

In fixing the problem, the insurance company not only removed the incorrect payment for the current month, but they also removed the correct payment for the previous month, meaning my son was now in arrears and at risk of losing his new insurance, even though we had followed all correct steps to transfer and set up automatic payment.

Furthermore, their customer service representative just reported his account now shows "paid" for the next five months, even though he has not paid past the current month.

Case #3

"Global roaming" on a mobile phone is essential when traveling overseas. I recently had to activate the plan that gives me a discount on data when traveling abroad, which is important for a smart phone. Well, this took several calls with conflicting information from the various agents at my mobile service provider. One person said it was not necessary, another said it could be done now and I would be all set. A third person actually took me through the steps to change my iPhone settings so it would work. Had this third person not explained the setup to me, the phone would not have worked.

I'm sure you must have some stories yourself. Why not share them with us?

If you run a service or support operation, learn how to understand what your customers really want. It will earn you customer loyalty and save you money from multiple mis-handlings by your staff.

To learn new QFD tools for this, I recommend attending the QFD Green Belt^® course. I will be teaching the Orlando course on Feb. 28 - March 1, 2013. You will learn how to apply QFD correctly and most efficiently from the first time.

The course includes Excel templates which is an economical alternative to buying commercial software that is most likely based on outdated methods. The course has no prerequisites.

Glenn

“Did you find everything okay?”

It’s a question consumers hear on a daily basis, whether they’re at a grocery store, electronics store, sporting goods store or basically any kind of retail outlet.  Sometimes our answer is ‘yes’ and other times ‘no,’ but what never seems to change is the outcome from this little encounter.  Anyone reading this blog probably already understands why – because it’s not a service question, it’s a marketing statement.

Much like “Welcome!” from greeters at many mega stores, this simple line is meant to project a customer-first attitude amongst a store’s employees (and at no additional cost!,) however, unlike a throwaway greeting, this question represents a much greater missed opportunity.

It is not that the asker (often a cashier) is disingenuous when asking this question, but rather the question itself is problematic and their training does not enable them to deal with the voices of customers they receive.  It is an avenue for feedback, but it almost always leads to a dead end.

The most immediate problem with this question is that it’s vague and open to multiple interpretations by different customers.  One of the main principles of asking good questions is making sure the respondent actually knows what’s being asked.

The first possibility that springs to my mind is, “Was the process of finding specific product groups and making selections easily accomplished?” This can be broken down in at least three ways as follows:

• “Was our inventory organization logical to you?” 
• “Was our inventory accessible to you?”  and 
• “Did we provide enough information to help you decide?”  

There are likely more ways to break down the process of shopping, but it’s worth noting that an online store like Amazon, which has begun to enter the grocery business in some cities, can easily meet these needs without much extra effort through their existing online interface.  This makes it all the more important for today’s brick and mortar grocery stories to satisfy in these areas.

Another way to interpret the question is, “Do we carry the specific items you’re looking for?”  – either by item type or item brand. This is an issue of supply management and no amount of friendly customer service is going to help the customer get what they want on that current trip.

There might, however, be an easy and visible method for customer requisitions, which would not only please a customer but also guarantee a return visit when their item arrives.  This is often possible at electronics stores (although the process is far from visible or easy) but is rarely possible in grocery stores.  When a customer’s favorite brand of mustard or bread goes missing and they ask an employee why they no longer carry that item, they’re often met with an “I don’t know” which is neither helpful nor informative. The excruciating weakness of that response is that it could be!

Even when store representatives ask meaningful questions and their customers provide informative answers, they’re rarely trained with the necessary tools or provided a response channel to turn that voice of customer into helpful information.

Every time the question is asked, a store is in position to receive useful feedback, both positive and negative, yet that information goes nowhere; it gets stuck with a clerk who doesn’t know who to give it to or a manager who doesn’t want to receive it. “Did you find everything okay?” is a façade of customer-first thinking, and fortunately there’re ways to improve it.

An easy start is to ask better questions, and to make sure your representatives know how to respond when the customer's answer is “no.”  A working response channel from customer to representative to management is important, however this is dependent on a customer’s time, mood and memory and may lead to skewed results.

For instance, feedback on message boards tends to occur more when something has gone wrong, rather than when something has gone right.  Questionnaires sent out by grocery stores tend to be focused on their own product or process rather than the customer’s experience (or their desired shopping outcome), and by the time customers receive them, they may not remember all of the relevant details from their shopping encounter.  Furthermore, even if a customer did have difficulty searching through a store’s shelves and a cashier was able to help them, what good would it do if the customer had already waited in line and was about to pay (as they often are when the question is asked)?

For these reasons, going to the gemba is the most effective way to find customers’ needs in order to improve their shopping experience.  True customer-first thinking means discovering if they “found everything okay” (and everything it entails) before they check out of your store.

Ken Mazur

Related Read...

• Trusting Front Line Employees To Be Customer Advocates 

• Translating Voice of Customer into True Customer Needs 

• Electronic Medical Records in the Gemba 

• Service QFD and State-Transition Diagram

When your EOB becomes an SOB!

When is information from a service provider (or any vendor) too little or too much? I'd like to share a recent experience with my health insurance company.

When It Is Too Little. 
My university offered me health insurance on an "opt-out" basis, meaning I was included unless I chose not. The insurance would only covered me and not my family, so I did not want it. I missed the opt-out deadline, and unbeknown to me, I was added to the university policy, which used the same health insurance company as my family policy.

This insurance company, seeing two policies under my name, automatically dropped my family policy. They did not call me, they did not write me; they just sent me a refund check in the mail.

When I received the check, I called them to find out why – it was a refund of my family policy which has been in place over decades with no lapse in premium payment, and yet they decided to cancel it without ever asking me. Stunned and outraged, I had to buy a separate "bridge" policy for my family from a different insurance company.

Eventually I was able to reinstate my cancelled family health insurance policy and get off the university plan, but it took a month of calls to both the insurance company and university and dealing with their bureaucratic processes before finally getting things straighten out.


When It Is Too Much. 

Yesterday, my insurance company just sent me a revised EOB (explanation of benefits), about a hospital treatment from a few months ago, for which they had already reimbursed since then. I have the original hospital bill as well as the first EOB showing a balance of $0.00.

However, the revised EOB I just received indicated that nothing had been paid to the hospital and that I was responsible for the full amount (it was expensive!).

I called the insurance company and they explained these details: After the original bill was reimbursed, the hospital lowered their price (hospital billing error) and re-sent a smaller bill to the insurance company. This triggered the insurance company to "take back" the original payment and send me a revised EOB explaining nothing had been paid.

Then, the insurance company paid the hospital the lower amount, and issued a "revised, revised EOB" showing that my balance was now $0.00 again. This revised, revised EOB will be mailed to me next week, they tell me. How confusing!

In other words, in this case the insurance company, for some internal reason, decided to write to me the intermediate information that I did not need to know. Because of this intermediate and incomplete information, I became very worried and spent a lot of time, trying to find out what happened. It would have been better had they told me nothing and just handled the transaction between the hospital and the insurance company. SOB!

Kansei Engineering and Education

One of the "cousin" methods we use in Modern QFD is called Kansei Engineering, which I often translate as emotional quality (when used by itself) or lifestyle deployment (when combined with QFD).

The original concept creator, Dr. Michio Nagamachi, also uses it for ergonomics (both physical and emotional) in order to elevate a produce above its pure functionality.

In a January 5, 2013 article in the New York Times by Al Baker, "Ergonomic Seats? Most Pupils Squirm in a Classroom Classic", the subject of school chairs interested me greatly. It seems that even today, most schools see chairs as a means to corral children so they can learn in the traditional school settings that date back to the 19th century 5-S approach: sit straight, speak only when spoken to, study only the books we approve, store easily, and save money.

Saving money seems to still trump the others, as schools continue to buy chairs that will last 30-50 years. Despite a German study and recent experience that children's comfort and engagement are improved with more ergonomic and mobile chairs, schools are slow to change. Professor Galen Cranz in her 1998 book "The Chair: Rethinking Culture, Body and Design," wished child movement were accorded more consideration.

From a QFD and Kansei perspective, children should be seen as "customers" and users of the chair.  Today's classrooms, group work, electronics, and other educational tools should be observed in "gemba" visits (actually go to a classroom and see how teachers and students interact), so that 21st century chairs and desks can be created to help children achieve their educational goals.

I know observing children is problematic, and adjustments to the gemba methods must be made. You may find these papers helpful:

• "Jurassic QFD" (1999) where children were observed in a petting zoo during the design of an animatronic triceratops

• "Elementary QFD: Using QFD to Assess and Evaluate the Learning Environment of a Private School Library and to Systematically Engage an ISACS Review" (2012) where an elementary school library was evaluated for improvement.

• "Brand Engineering using Kansei Engineering and QFD"(/u> - a student research paper on chair design by using Kansei Engineering and QFD.

Capturing voice of social network and using it

Brian X. Chen reports in the January 2 2013 Bits section of the New York Times, "The iPhone Goofs Up on Telling Time, Again," that the new Do Not Disturb (DND) function on iOS6 iPhone failed to turn off for many users on New Years Day.

This is a new feature that allows iPhone users to set a quiet time (like when you sleep) to block incoming calls and alerts. It is suppose to turn itself off at a pre-determined time so that calls, alerts, and alarms can be heard.This bug is even more noteworthy because it is featured in a new television commercial airing this week. NYT readers first blasted Apple for the bug, and then turned on themselves for whining about such a small inconvenience.

This brings to mind two QFD concepts. The first is the famous "Sales Point" column in the quality planning table room on the right side of the House of Quality matrix (or done independently in Blitz QFD^®) where a selling point is given extra weight which eventually strengthens the improvement calculation for related technical requirements. Below is one example of a HOQ with Sales Points weights (the yellow highlighted column).

The purpose of the "sales points" column has been frequently challenged as it seems to do the same job as the relative importance and the level-up columns, and is thus redundant. Dr. Akao's purpose, however, was to add a sales point value when the associated customer need is going to be promoted, as in the case of this Apple commercial. The added weight would direct engineers and software developers to  pay more attention to its auto on/off functionality.

The second point, I commented myself back to the New York Times:

"I see the DND issue as one of software quality. Developers often have incomplete or inaccurate use cases around which they design their features and code. They do not fully understand how the feature gets used in real life, and so sometimes get it wrong. Like the proverbial mushroom, they are kept in the dark and fed s**t!

It is comments from users like you who post here that can provide the necessary insight to do the job right the first time. There are methods for analyzing the voice of the customer, like QFD, that actually build on your feedback and help marketeers and engineers do their jobs better. So keep on blogging and contributing your experiences - we will all benefit."

My second point is that every opportunity to get customer feedback should be welcomed by a company. Many companies do monitor social media as part of their customer relationships management (CRM) programs, but not all companies forward the information to new product development departments.

The customer voice table is the QFD tool for analyzing these comments. In order to give engineers direction for improvements and next generation products, negatives and complaints should be reversed into positive statements, and technical solutions should be translated into product independent customer needs.

Related Reading...

• QFD for Software and IT Projects

• QFD for Predicting Future Technology Risks

• Trusting Front Line Employees To Be Customer Advocates

• Learn Blitz QFD^® tools ... QFD Green Belt^® Certificate Course

Why we drink beer?

As we celebrate the various holidays and new year in our own special ways, let me propose a toast – of Singha Beer!

This week, the American Society for Quality (ASQ) posted as an "Editor's Pick" on their Knowledge Center a QFD case study done by Singha Beer of Thailand. The response has generated a lot of interest and ASQ plans to post it on their home page.

Unlike most QFD applications, this case had little to do with the product, and much to do with the marketing and branding message – not what we drink but why we drink.

Here is the link to the article "Thai Brewery Deploys QFD Tools to Tap Into Consumer Motivation" (PDF) at ASQ site.

Enjoy.


PS: The QFD Institute also has a synopsis of this case study 
       "Why We Drink Beer?" (web view).

QFD at Holiday Time

The holiday season is a great time to sharpen our QFD skills. Here are some techniques that might make the celebrations and shopping a little easier.

• Gift shopping for someone? Instead of asking them what your should buy (a solution), try asking for what they need (what difficulties do they have at work or home, what opportunities do they wish for, how would they like others to see them)? This helps us practice the Customer Voice table where we translate VOC into true needs.

• Hard to choose among several options for a gift, a restaurant, or a party to attend? Practice your alternative selection technique.

1. First list your options.
2. Write down what is attractive about each option, and what is unattractive about each option. Convert unattractive statements into positive ones. For example, this restaurant is "too far away" becomes "nearby." These are your judgment criteria.
3. Prioritize the judgment criteria. For emotional decisions, AHP's pairwise decision making is a great way to work through them.
4. The highest priority judgment criteria will drive your decision. Look at which option best fulfills them. Feel comfortable that you made the best choice possible given all the wonderful options.

• Have to be in two places at once? Try TRIZ (Theory of Inventive Problem Solving). See Glenn Mazur's web page http://www.mazur.net/triz/ for details.

1. Define your dilemma using the Engineering Parameters in Table 2 in the above link. For example, I am invited to two parties at the same time – my best friend and my in-laws. One contradiction is improve EP 26 Amount of Substance (I want to improve my pleasure for the afternoon) without the undesired result of EP 13 Stability of Object (I don't want my marriage to become unstable).
2. Look up the pair in the Table of Contradictions to find Inventive Principles 15, 2, 17, 40. Let's see what solutions we can invent.

    IP 15. Dynamicity.

1. Make an object or its environment automatically adjust for optimal performance at each stage of operation. Have the meal at your in-laws (so you can compliment her cooking) and dessert at your friends (so you can stay late).
2. Divide an object into elements which can change position relative to each other. Same as above, but decide that day where to go first.
3. If an object is immovable, make it movable or interchangeable. E-mail your suggestions to qfdi@qfdi.org

    IP 2. Extraction.

1. Extract (remove or separate) a "disturbing" part or property from an object.
2. Extract only the necessary part or property. Exchange gifts, have a drink at the in-laws and then see your friends.

    IP 17. Move to a new dimension.

1. Remove problems with moving an object in a line by two-dimensional movement (i.e. along a plane). Invite in-laws and friends to your house, instead. Have one party upstairs and the other downstairs.
2. Use a multi-layered assembly of objects instead of a single layer. Add pleasure to visiting your in-laws by inviting your friends to come with you. Or, have lunch with in-laws and dinner with friends.
3. Incline the object or turn it on its side. E-mail your suggestions to qfdi@qfdi.org

IP 40. Composite materials.

• Replace a homogeneous material with a composite one. Take two cars, and divide the family up so each can stay as long as they want at either party.

 

Young business travelers' technology needs

Over 15 years ago, the Delta Hotel chain in Canada sought to attract business travelers by being one of the first major hotel chains to offer business-oriented office suites. Notably, at the time, these suites included a computer which could allow business travelers to work on the road, instead of being “stranded” from the office in an era when laptops were costly and scarce.

Unfortunately, the designers of these rooms didn’t entirely understand the needs of their targeted customers or what being productive entailed to them (read details in "Close Encounter of the QFD Kind", a white paper PDF).  While the offices were fully furnished, the computers were not — they did not come with commonly used software packages, meaning the guest not only had to bring their own software disks with them but would also have to waste time installing the programs themselves, in order to get any use out of the computer besides Solitaire.

Today, we consider an office space, complete with Microsoft Office^® or Open Office^® as well as access to a printer, to be standard in any hotel chain, but do these actually make us more productive?  Technologically speaking, these accommodations are obviously better than what Delta offered years ago, however they represent an even more grievous misunderstanding of customers’ needs than was found on the blank computers back then.

From a QFD perspective, these computers are seen as a feature, and although they’ve been tweaked and upgraded over the years (their performance level is higher than ever), they address needs that have already been met by much better alternatives, and fail to address newer needs that have been enabled by changing technology.

Widespread usage of laptops and tablets have made office suite computers unneeded, the prevalence of proprietary software and custom remote login systems have made them unusable, and the nature of the internet and shared computer usage have made them unsafe. Furthermore, the original underlying need for productivity has been joined by the needs for entertainment and communication, and in that regard there is very little opportunity for hotel offices to compete with gaming laptops, Facetime^® or Skype^®.

Rather than trying to meet these needs by offering competing features, hotels should be trying to facilitate the features customers already have that meet their needs.  Simply put, this means replicating (or besting) the connectivity customers have on their laptops, tablets and phones that they travel with.

For example, many hotels advertise access to broadband. Often these connections, however, perform quite poorly on technical benchmarks (bandwidth tests) and outright fail on customer benchmarks (ability to watch Youtube videos, play games or video chat and so forth).  This can be exacerbated by poor cell phone coverage, which may force a customer to leave the hotel in order to be reachable at all.  If there’s any doubt that failing to meet travelers’ needs of connectivity can affect repeat business, one survey found that nearly 60% of travelers aged 35–54 would consider a different hotel option if they had poor cell phone reception during their previous stay.


This actually falls into the 'reverse quality' category in the Kano model of expected quality vs. exciting quality. What is exciting quality for older generations of hotel guests (such as having free internet and computer access) has not only become expected quality for younger hotel guests, but also the poor fulfillment of hotel room TV and internet may even be reverse quality — that is, their existence dissatisfies!

Any hotel that’s serious about catering to business travelers must understand these needs, as well as other needs such as internet security, in a modern and changing context, rather than continuing to refresh old features.

Ken Mazur

Related Read...

• "General Motors and Gemba Maestro: How to translate VOC into true customer needs"

•  "Defining Luxury for Today's Business Travelers"

• "Translating Voice of Customer into True Customer Needs"

Microsoft Office^® is a registered mark of Microsoft, Open Office^® Apache Software; FaceTime^® Apple Inc.; Skype^® Skype.

  

People of the 2012 QFD Symposium

Once again new case studies were shared and emerging ideas were brought to the public last Friday at the 24th Symposium on QFD in sunny St. Augustine, Florida USA.This year’s presentation topics were as unique and diverse as the presenters, whose hard work and dedication was greatly appreciated.

Even in today’s trend toward everything virtual, face-to-face interactions produce much deeper impact and networking bonds, we’ve found. Let us introduce some of the wonderful individuals we met at this year’s symposium:

Carey Hepler presented the first of its kind QFD application on the timeliest topic – politics. His project involved the election campaign in which his wife was a candidate for a local judiciary seat. He applied the Modern QFD tools to listen to the constituents’ voice, identify target segments, their needs and priorities, and finally develop the campaign strategy and deploy it in the most respectful way that we voters wish every candidate would.

By the time Carey completed his presentation, there was an outpouring sense of support and respect for Team Hepler from the symposium audience. We were captivated by this unique application of QFD and also appreciated the level of challenge that even the most qualified candidate can face solely because of the nature of politics.

Carey Hepler is a Certified QFD Black Belt® and 2010 Akao Prize® recipient. He has presented several QFD papers, including: “Finding Customer Delights” (2006 International QFD Symposium); “The Analytic Hierarchy Process: Methodologies and Application with Customers and Management” (2007 International QFD Symposium); “Getting Personal: How Blue Cross Blue Shield of Florida used Customized Communications to Reach its Members” (Journal of Healthcare Communications – 2008); “Predicting Future Health Insurance Scenarios Using QFD and Analytic Hierarchy Process (AHP)” (2008 American Society of Quality).

Carey currently works for Solantic Urgent Care, where he leads the operations of their walk-in urgent care centers and the development of an expansion blueprint. Prior to that, Carey was with Blue Cross and Blue Shield of Florida, AT&T Universal Card, and Citibank.

Jack B. ReVelle, Ph.D., presented his unique experience in consulting Tangshan Railway Vehicle Company in China and the challenges of introducing quality methods in a country where the government believes it speaks for everyone.

After the catastrophic accident of the nation’s first generation bullet train that resulted in dozens of fatalities, the Chinese engineers self-studied the QFD Capture® software and a House of Quality matrix in hope of addressing the quality and safety issues that manifested in the 2011 accident.  Jack was invited to consult the Chinese team on some of the QFD techniques and analytic methods such as gemba study, how to convert the VOC data to specifications, thematic content analysis, MS Excel® sorting, affinity and Pareto analysis.

Unfortunately, the project became mired in multiple interests competing for authority including the Chinese Ministry of Railways, and basic communication became difficult and the line of decision making and progress unclear. It was a telling moment when one member of the symposium audience asked Jack, “Will you ride this new bullet train in China?” We do hope the Chinese heed his advice.

Jack ReVelle is a consulting statistician and the principal of ReVelle Solutions, LLC. He has received many honors throughout his career, including the 1999 Akao Prize®. We’ve known Jack from the old days of QFD but during the St. Augustine meet, we discovered that he was the commander of the U.S. Air Force Explosive Ordnance Disposal Team that was involved with the “Broken Arrows” incident in Goldsboro, the 1961 nuclear weapons mishap where a strategic bomber B-52 disintegrated in mid-air in North Carolina and Jack’s team was dispatched to take care of the two atomic bombs that fell out of the aircraft. We hear a new movie is being considered based on this and look forward to Jack’s heroic history being told in movie theaters.

Karthik Jeganathan presented the "Change Fix Model” for IT projects where volatility of customer needs and design requirements is always a big challenge.

The model aims at improving agility of the change risk estimation by using lean and QFD tools. It measures the impact of a change by using a regression model, enabling assessment of the impact from a change through the entire software lifecycle, starting with a regression model for establishing the relationship between impact of change and additional effort for implementing the change. This provides a mechanism to measure the volatility and score the quality of the requirements with respect to the importance of prioritizing and baseline requirement changes in agile as well as a non-agile environments.

Karthik presented a case of a major communications company and the evaluation of the method which showed near 80% estimation accuracy. The tools used for the Change Fix Model include: a) CTQ drill down tree; b) Effort benefit matrix; c) Regression model; d) RCA and Pareto; and e) Likert scale scoring using percentiles and box plots.

Karthik works as a Senior Six Sigma and Transformation consultant at Cognizant Business Consulting Team, both in India and the USA. He has 10 years of industry experience working in Management and Transformation Consulting, is a MBB, CISA, and Certified ITIL V3 Foundation Professional.

Tasneem Alfalah aims to develop a conceptual model that integrates the SERVQUAL Gap model and QFD for Jordanian mobile telecommunications industry that has become a viable force to the nation’s economy. This study is currently in the first stage where a questionnaire based on the SERVQUAL framework is being designed, administered and analyzed. The study population will comprise all Jordanian mobile telecommunication companies located in Amman, the nation’s capital.

The QFD model will be useful for evaluating the customer satisfaction vs. actual experience of service level, identifying the quality shortfalls and weak attributes, and finally presenting the areas of immediate improvement as well as attractive attributes that would help their business continues to grow in the future. 

Tasneem Alfalah received an MSc in Quality Management from the University of Jordan in 2010. She next worked as a lecturer and research assistant for one year before being granted a scholarship from her undergraduate alma mater Applied Science University to continue her Ph.D. studies in Glasgow Caledonian University in U.K. where she is currently in her second year.

We congratulate Tasneem for having completed the QFD Green Belt® Course in St. Augustine, receiving a provisional certificate. Next year she plans to attend the QFD Black Belt® Certificate Course. We look forward to finding out how she would incorporate the new knowledge of Modern QFD tools in her research approach.

Dipl.-Ing. Philipp Tursch, a Ph.D. candidate at the Chair of Quality Management, Brandenburg University of Technology in Cottbus, Germany, presented the Repertory Grid Technique and its potential use in QFD. The Repertory Grid Technique was developed in 1955, initially as a clinical methodology for interviewing patients for psychological diagnoses. It has since evolved to a set of general guidelines used in a wide variety of domains including environmental studies, education, healthcare, business and quality management where it is tried as a way to determine the unconscious, individual and elusive dimensions of customer perception.

Philipp’s research focuses on potential integration of this method in product development and QFD, namely in identifying customer preference concerning a new product. He showed how it works by using an example of German smart phones where a range of physical characteristics were shown to potential consumers and their preference for physical attributes of the mock phones were tabulated.

This was Philipp’s first presentation of his research in the U.S. The methodology has a similar feel to Kansei Engineering, except Kansei abstracts up to a high level brand concept, by encompassing both physical and emotional attractiveness, and using a series of regression and multivariate math. We look forward to future progress in Philipp’s research.

Ken Mazur presented a Modern Blitz QFD® case in a non-traditional model – a school (K-8). He shared several unique insights that often go unnoticed:

1. In schools, the end-user / primary customer (students) typically have the least influence over educational decisions even though they are most affected by them; 
2. the secondary customer (parents who pay the tuition) have a greater role in decision-making for their children’s education even though their educational expectations reflect more on their own past experience, not necessarily future needs; 
3. often organizations act on a situation without fully determining the true needs of the stakeholders, jumping on reactive solutions that address problems inadequately or sometimes even exacerbate it and waste resources; 
4. functional isolation resulting from departmental divides hinders organizations from seeing a large picture when day-to-day problems are reported by individual departments, and their impact on the whole organizational performance is underestimated unless a systematic method like QFD is used and the analytic results can be documented in a way that is visible to everyone.

In his debut QFD case, Ken managed to deploy Modern QFD fully, from the initial Gemba study to VOC analysis that revealed unexpected findings, AHP evaluation of priorities, and suggestions for systematic deployment of solutions on the most important needs, taking into consideration school resources and ease of implementation.

Ken hopes to conduct the second phase of QFD with this school, eventually training the school staff so they would be able to utilize QFD tools and thinking on their own in the future. Ken’s primary interest is working with non-profits and NGOs that would benefit from using QFD to better serve their communities.

Next year, the QFD Institute will host the 19th International Symposium on QFD in Santa Fe, New Mexico on September 6-7, 2013. Everyone is welcome to participate, whether you are new to QFD,  studied it many years ago, currently actively using it, or plan to try it in a future project.

Call For Papers is now in effect for those who wish to present at the 2013 symposium. We expect many QFD experts from overseas, including Dr. Yoji Akao, founder of QFD methodology. So please plan to join us next year!