Niemeijer et al., 2011
9 generic project definitions in healthcare:
1. Improve utilization of 5. Decrease cost by reducing
equipment/facilities unnecessary use of resources
2. Improve productivity of personnel 6. Decrease cost by reducing inventory
3. Decrease cost by improving 7. Increase revenue by improving
purchasing processes registration
4. Decrease cost by reducing 8. Increase revenue by admitting more
complications patients
9. Increase revenue by expanding
capacity
The CTQ Flowdown as a Conceptual Model of Project Objectives - De Koning & Mast, 2007
Potential quality improvement projects → project selection → definition of the project's
objectives
● "Besides lack of clarity about the project's objectives, the rationale and assumption on
which the project definition is based often lack explication as well"
● "Many standard approaches for quality improvement projects prescribe that the first
step of a project is to explicate the objectives of the project in the form of measurable
indicators"
○ "In the Six Sigma approach the translation of a more or less specific project
definition into one or a few measurable indicators is done in the define and
measure phase"
CTQ downflow: Tool used to go from project definition to measurable CTQs
● Aim: Make the rationale underlying the project explicit and structured
● "It lacks a precise formulation and theoretical grounding"
● "CTQ flowdowns generally consist of various canonical layers of nodes and canonical
relationships"
● Aids in deploying and executing quality improvement projects
Layers 1 and 2: Strategic Focal Points and Project Objectives
Link between the layers "is established by a type of relationship called action planning"
● Action planning: "The translation of strategic focal points to project objectives"
○ Goal: "Before-the-act specification of behavior"
○ "In particular, strategic focal points are translated into improvement programs,
which, in turn, initiate and coordinate improvement projects"
● "To translate strategy into actions, projects are defined"
● "Project objectives delineate an improvement project and serve as a yardstick of
project success"
Rationale of the project: How do objectives link to the bigger scope and strategic focal points
in particular?
Precise definition of the objectives: Clear and articulated account of the 'what' and 'why' that
helps communicate motivation for and exact goal of the project
Layers 2 and 3: Project Objectives and One-Dimensional Variables
The link b/w these two layers is based in the deconstruction of the (aggregate) objectives to
make the objective more precise
, ● "Further, this translation into one-dimensional variables is a first step toward making
the project objective measurable"
● This link is called a 'part of' relationship
● "An aggregate decomposed into its constituting dimensions is called a Cartesian
product structure in the theory of semantic networks"
Layers 3 and 4: One-Dimensional Variables and Their Additive Constituents
Further decomposition of variables (e.g., throughput time being decomposed as the sum of
processing and waiting time)
● The Pareto principle later helps determine which constituents are dominant and "helps
to focus the project and reduces the scope"
Level 5: Measurements
"The gap b/w CTQs and the real of measurements is bridged by operational definitions" which
make them "measurable by specifying a measurement procedure"
● Determine what will be measured per what (can be time)
● "By giving an operational definition for one or a few CTQs, the project leader defines a
template for data collection (a measurement plan)"
● A measurement plan has the structure of a data-matrix where rows are units and the
columns CTQs
● "Making the meaning of concepts more specific by giving an operational definition
ensures that the statements in which they occur are testable and that they lend
themselves to use in explanations and predictions"
Conceptual Modeling of the Causal Structure of Problems
"A hallmark of quality improvement programs is the principle that improving a process requires
an understanding of how it works"
● "To understand a process means that one is able to relate the behavior of the CTQs to
so-called influence factors"
Conclusions
1. "The CTQ flowdown makes explicit the business economic rationale for the project"
2. "The project is placed in its larger scope", what is excluded is explicit
a. "Modeling the larger business economic scope enables one to identify the real
drivers of performance, and thus allows the verification that the project is
tackling one of the vital few issues"
3. Assumptions are made explicit
4. CTQ flowdown serves as a communication tool
Purposes of making concepts measurable:
1. "Effective problem-solving activities and improvements are based on well-defined,
crystal-clear problem definitions"
2. Focus on the most important (sub) problems by showing magnitude (Pareto principle)
3. Shows trade-offs
Quality Quandaries: An Efficient Public Sector - Lokkerbol et al., 2012a CASE STUDY
Define phase: Focus on the digitization of WIA documents
● Expected improvements include shortening the throughput time and rework, yearly
benefits of $250,000 due to reduction in personnel were also expected
9 generic project definitions in healthcare:
1. Improve utilization of 5. Decrease cost by reducing
equipment/facilities unnecessary use of resources
2. Improve productivity of personnel 6. Decrease cost by reducing inventory
3. Decrease cost by improving 7. Increase revenue by improving
purchasing processes registration
4. Decrease cost by reducing 8. Increase revenue by admitting more
complications patients
9. Increase revenue by expanding
capacity
The CTQ Flowdown as a Conceptual Model of Project Objectives - De Koning & Mast, 2007
Potential quality improvement projects → project selection → definition of the project's
objectives
● "Besides lack of clarity about the project's objectives, the rationale and assumption on
which the project definition is based often lack explication as well"
● "Many standard approaches for quality improvement projects prescribe that the first
step of a project is to explicate the objectives of the project in the form of measurable
indicators"
○ "In the Six Sigma approach the translation of a more or less specific project
definition into one or a few measurable indicators is done in the define and
measure phase"
CTQ downflow: Tool used to go from project definition to measurable CTQs
● Aim: Make the rationale underlying the project explicit and structured
● "It lacks a precise formulation and theoretical grounding"
● "CTQ flowdowns generally consist of various canonical layers of nodes and canonical
relationships"
● Aids in deploying and executing quality improvement projects
Layers 1 and 2: Strategic Focal Points and Project Objectives
Link between the layers "is established by a type of relationship called action planning"
● Action planning: "The translation of strategic focal points to project objectives"
○ Goal: "Before-the-act specification of behavior"
○ "In particular, strategic focal points are translated into improvement programs,
which, in turn, initiate and coordinate improvement projects"
● "To translate strategy into actions, projects are defined"
● "Project objectives delineate an improvement project and serve as a yardstick of
project success"
Rationale of the project: How do objectives link to the bigger scope and strategic focal points
in particular?
Precise definition of the objectives: Clear and articulated account of the 'what' and 'why' that
helps communicate motivation for and exact goal of the project
Layers 2 and 3: Project Objectives and One-Dimensional Variables
The link b/w these two layers is based in the deconstruction of the (aggregate) objectives to
make the objective more precise
, ● "Further, this translation into one-dimensional variables is a first step toward making
the project objective measurable"
● This link is called a 'part of' relationship
● "An aggregate decomposed into its constituting dimensions is called a Cartesian
product structure in the theory of semantic networks"
Layers 3 and 4: One-Dimensional Variables and Their Additive Constituents
Further decomposition of variables (e.g., throughput time being decomposed as the sum of
processing and waiting time)
● The Pareto principle later helps determine which constituents are dominant and "helps
to focus the project and reduces the scope"
Level 5: Measurements
"The gap b/w CTQs and the real of measurements is bridged by operational definitions" which
make them "measurable by specifying a measurement procedure"
● Determine what will be measured per what (can be time)
● "By giving an operational definition for one or a few CTQs, the project leader defines a
template for data collection (a measurement plan)"
● A measurement plan has the structure of a data-matrix where rows are units and the
columns CTQs
● "Making the meaning of concepts more specific by giving an operational definition
ensures that the statements in which they occur are testable and that they lend
themselves to use in explanations and predictions"
Conceptual Modeling of the Causal Structure of Problems
"A hallmark of quality improvement programs is the principle that improving a process requires
an understanding of how it works"
● "To understand a process means that one is able to relate the behavior of the CTQs to
so-called influence factors"
Conclusions
1. "The CTQ flowdown makes explicit the business economic rationale for the project"
2. "The project is placed in its larger scope", what is excluded is explicit
a. "Modeling the larger business economic scope enables one to identify the real
drivers of performance, and thus allows the verification that the project is
tackling one of the vital few issues"
3. Assumptions are made explicit
4. CTQ flowdown serves as a communication tool
Purposes of making concepts measurable:
1. "Effective problem-solving activities and improvements are based on well-defined,
crystal-clear problem definitions"
2. Focus on the most important (sub) problems by showing magnitude (Pareto principle)
3. Shows trade-offs
Quality Quandaries: An Efficient Public Sector - Lokkerbol et al., 2012a CASE STUDY
Define phase: Focus on the digitization of WIA documents
● Expected improvements include shortening the throughput time and rework, yearly
benefits of $250,000 due to reduction in personnel were also expected
