Problems and solutions of theme selection of China’s hospital quality control circle
Review Article

Problems and solutions of theme selection of China’s hospital quality control circle

Tingfang Liu, Dan Zhang, Haini Jiang

Institute for Hospital Management of Tsinghua University, Tsinghua University, Beijing 100084, China

Contributions: (I) Conception and design: T Liu; (II) Administrative support: T Liu; (III) Provision of study materials or patients: D Zhang; (IV) Collection and assembly of data: H Jiang, D Zhang; (V) Data analysis and interpretation: H Jiang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Tingfang Liu. Senior Adviser of Dean of Institute for Hospital Management of Tsinghua University, Professor, Graduate Student Supervisor, Tsinghua University, Beijing 100084, China. Email:

Abstract: Based on the case analysis and questionnaire survey, this research finds out that the majority of China’s hospitals use evaluation method to choose the theme of quality control circle (QCC). Problems of the existing way of using evaluation method includes: (I) definitions of some evaluation dimensionalities are lack of accuracy; (II) some of key evaluation dimensionalities are missing; (III) there is no weight among different evaluation dimensionalities; (IV) only the inside QCC members participate in the theme selection. To solve those problems, this article puts forward the following suggestions: (I) adjust the evaluation dimensionalities; (II) complete the weight of evaluation dimensionalities; (III) establish the mechanism of outside participation.

Keywords: Hospital quality control circle (hospital QCC); theme selection; dimensionality; weight; outside participation

Received: 29 August 2016; Accepted: 06 September 2016; Published: 15 November 2016.

doi: 10.21037/jrh.2016.09.04

Peter F. Drucker once pointed out, in all organizations, hospitals have the most complex workflows (1). To solve the potential safety problems, except for the traditional management methods, it needs to introduce the management tools (1). Quality control circle (QCC) is one of the most important management tools in hospital. It has the bottom-up feature (2), which arouses medical staff’s enthusiasm of actively getting engaged in the quality management, thus initially forming the long-term mechanism of hospital quality management.

QCC was introduced late in China but developed rapidly. Achievement of Tingfang Liu’s Applied Research of Suitability of Quality Control Circle in Chinese Hospitals and the successful outcome of two contests of National Quality Control Circle Competition of Chinese Hospitals greatly promoted the application of QCC in China’s hospitals. In order to achieve the purpose of using QCC to continuously improve the medical quality, it is important to select a valuable, significative and practical theme of QCC.

QCC activity contains 4 stages and 10 steps (Figure 1). Theme selection is the step that QCC members use discussion, voting and other methods to choose one proper theme out of candidate themes, which always root in the problems frequently occurring in the daily work. “Problems” mean the gap between status quo (current level) and ideal state (objective) (3,4). Based on the analysis of competing circles of National Quality Control Circle Competition of Chinese Hospitals, following four problems existed in some circles’ theme selection: (I) theme is too simple, to carry out QCC will result in waste of resources; (II) theme is too complex. After spending a lot of time and effort, it is still unable to achieve the purpose of quality improvement; (III) theme range is too broad. It is difficult to achieve the goal in one QCC period; (IV) theme is repeated. It doesn’t learn from the standardization experience of related QCC.

Figure 1 QCC’s 4 stages and 10 steps. QCC, quality control circle.

Above problems reflect that still there is room for improvement of current methods of theme selection. This research intends to investigate the current situation of theme selection in China’s hospitals, summarize the problems and reasons and innovate the mechanisms of theme selection.

Research materials and methods

This research adopts case analysis and questionnaire survey to investigate and analyze the current situation of theme selection in China’s hospitals.

First, case analysis is carried out. Cases come from China Federation for Hospital Quality Control Circle. There are altogether 396 QCC cases in the case library, of which there are 354 tertiary hospitals and 42 second-class hospitals. Specific sample characteristics are shown in Figure 2.

Figure 2 Sample characteristics.

And then, select Tongji Hospital of Tongji Medical College of HUST, People’s Hospital of Jilin Province, and Shanghai Pudong Hospital to conduct questionnaire survey. Conduct stratified sampling of nurses, doctors, technicians, logistical personnel, and administration staff. The questionnaire contains seven parts, including basic information, theme selection, real cause verification, solution formulation, standardization, outside participation and glossary. Issue 100 copies to each hospital, altogether 300 ones, and finally recover 280 valid copies, the effective rate was 93.3%. Aiming at three parts, basic information, theme selection, and outside participation, this study uses SPSS 21.0 to do the statistical processing. The actual composition of the survey sample is shown in Table 1.

Table 1
Table 1 Survey sample composition
Full table

Results and discussion

Based on the case analysis and questionnaire survey, this research finds out that the majority of China’s hospitals use evaluation method to choose the theme of QCC. Using “evaluation method” requires each member to rate every candidate theme according to the evaluation dimensionalities. The candidate theme with the highest score sum or the highest average value will be chosen as the theme of the current QCC. The result of questionnaire survey shows that circle members interviewed think some problems are existed in the evaluation method. A total of 74.4% of interviewees think definitions of some dimensionalities are lack of accuracy thus causing difficulties in evaluation; 70.8% think current evaluation dimensionalities are not comprehensive enough; also 70.4% members hold the idea that there is no weight among evaluation dimensionalities that their different importance can not be revealed. Through statistical analysis, there are following problems of using evaluation method.

Lack of accurate evaluation dimensionalities

Mainland China hospitals have been learning from the advanced experience of Taiwan, sometimes directly introducing some dimensionalities, like “superior policy”, which has been adopted by the majority (83.65%) of QCC circles. However, whether the dimensionality of “superior policy” is applicable in the mainland remains questionable. For one thing, its reference is ambiguous. There is no clear conclusion of whether “superior policy” refers to national macroeconomic policy, local regional policy, or the hospital’s own development policy. For another, being in line with the superior policy does not necessarily represent leadership’s attaching importance to the specific topic. Admittedly, leadership will concern the matter of policy. However, leadership will pay more attention to the issues directly affecting hospital’s survival and development, such as improving patients’ satisfaction, saving medical costs, reducing medical errors and so on. And leadership’s emphasis will bring the institutional, financial and spiritual support, which is the key factor of assuring QCC’s implementation and development.

Moreover, there is no unified and accurate definition of evaluation dimensionalities that different circles and members will have misjudgment. For example, according to statistical results, 97.81% of QCC circles choose “capacity of QCC members” as one of the evaluation dimensionalities. But different circles have different understanding of capacity of QCC members. Some define it as the members’ educational background; some consider it as whether the theme needs different sections to cooperate; and some define it as the members’ proficiency degree of QCC tools. No unified definition of evaluation dimensionalities will affect circle members’ scientific judgment, thus affecting the accuracy of theme selection.

Lack of key evaluation dimensionalities

For example, “attainability” is the key dimensionality to judge whether the theme’s objective can be reached. This dimensionality is important because pre-judgment of “attainability in this period” can effectively prevent choosing the over-broad theme, which cannot be completed. However, only 2.99% of case QCC circles adopt this significant dimensionality, which identify that the majority of circles fail to take it into consideration.

Lack of weight among different evaluation dimensionalities

Weight is a relative concept. For a specific dimensionality, its weight is the relative importance of this dimensionality in the overall evaluation system. Weight helps separate the importance from several dimensionalities, thereby contributing to a more scientific evaluation. Yet the statistical result shows that, only 1.36% of circles have allocated weight to different dimensionalities while the majority have not taken weight into consideration.

Theme Selection confined to the inside

In practice, usually the inside members select the candidate themes on their own. In total, 51.4% of interviewees indicate that they have experienced great difficulties in theme selection due to limited thinking. Result of questionnaire survey also shows that facing problems, only 9% of circles will invite outside staff to take part in theme selection and after selecting a theme, only 19.8% of circles invite outside staff to reevaluate and confirm the theme’s appropriateness. Besides, when asking for advice, inside members usually turn to colleague of the same department for help while they have little communication with relevant departments. This shows that interactivity of inside and outside needs strengthening

Countermeasures and suggestions

Adjust the evaluation dimensionalities

When using “evaluation method” to select the theme, the most important thing to do is to choose the objective and comprehensive dimensionalities, and define every dimensionality accurate. Based on the advanced experience of mainland China and Taiwan, this research puts forward the suggestion that the basic evaluation system consists of four dimensionalities: leadership’s attention, capacity of QCC members, significance, and attainability in this period.

First, according to chapter “Lack of accurate evaluation dimensionalities”, reference of “superior policy” is ambiguous and this dimensionality cannot represent leadership’s support and input of a specific QCC circle. Themes of QCC are always the problems that first-line medical staffs encounter in the daily work. Those problems do not have very close association with superior policy and they often can be solved within a department. So this paper suggests that instead of “superior policy”, the dimensionality “leadership’s attention” can be adopted. It measures whether leaders will attach great importance to some specific themes. Aspects need to be considered includes the theme’s relationship with the hospital’s development policy.

Second, QCC’s grass-roots characteristic decides the dimensionality “capacity of QCC members” is significant because it evaluates circle members’ ability, which determines whether the QCC activity can reach at the best results. “capacity of QCC members” should be understood as members’ comprehensive abilities, including the ability of putting forward questions, planning ability, logical thinking ability, application ability of statistical tools and QC tools (Gantt chart, characteristic diagram, tally sheet, Pareto diagram), professional working proficiency, humanities related capabilities (QCC’s name/badge/PPT designing, language competence).

Third, “significance” describes the theme’s importance. Take two aspects into consideration: (I) whether the theme will help continuous quality improvement; (II) among all meaningful candidate themes, which one is the most urgent one.

Last but not the least, to avoid selecting a too broad theme, “attainability in this period” should be taken into consideration. As for this dimensionality, members need to estimate not only the feasibility but also the probability to complete in this period.

It is noteworthy that if needed, according to different theme types, other dimensionalities can be added to above four basic dimensionalities. For example, “economical efficiency” can be added when candidate themes are about “cost”; “patient satisfaction” can be added when candidate themes are about “quality”; “challenge” can be added when candidate themes are about “efficiency”.

Complete the weight of evaluation dimensionalities

To select a theme more objectively and accurately, it is necessary to set weights for different evaluation dimensionalities. One thing to notice is that “human” is the decisive factor in all management activities, so the weight of “capacity of QCC members” should be enhanced appropriately. Besides, setting weight has no absolute standard. Depending on the specific circumstance, in consideration of management elements theory, QCC circles can allocate weight rationally. For example, there are two types of QCC, problem-solving type and issues-reached type. Generally speaking, for mature QCC circles, they can consider gradually beginning the more difficult issues-reached type QCC, which has a high demand of circle members’ capacity. Therefore, more weight should be allocated to “capacity of QCC members”. Take “control of hospital’s infection rates” for another example. Such kind of QCC types require multi-sectoral cooperation, so leadership’s emphasis, support and supervise are important. Dimensionality “leadership’s attention” should occupy higher weight.

Establish the mechanism of outside participation

The traditional opinion emphasizes that QCC is grass-roots, and inside members should spontaneously and actively solve problems by themselves. However, practice has proved that if QCC activities are confined to the inside members, after a certain period, it will lead to limitations and block, which will go against continuous improvement of medical quality. Besides, because of “human’s” involvement, the problems hospitals face are more complex and diversified than enterprises do. Considering above factors, this research holds the idea that it is necessary to establish the mechanism of outside participation to invite outside members to take part in the QCC activities. As for the theme selection, outside participation helps inside members to expand way of thinking, increase objectivity, and be more comprehensive. Outside members include staffs of the same department, staffs of the relevant departments, and chiefs of departments or leaders of the hospital. It is noteworthy that outside participation should not intervene QCC’s autonomy, democracy and independence. And not every QCC circle needs outside participation. Whether or not does QCC need outside participation, or what kind of outside participation it needs depends on the specific circumstances. To be specific (Figure 3): (I) when having difficulties collecting candidate themes, especially when the newly established circles can hardly find problems at work, inside members can invite staffs of the same department to participate; (II) under normal circumstances, after choosing a theme by inside members, staffs of the relevant departments can be invited to reevaluate the theme’s importance and feasibility; if encountering special circumstance, for example, the difficult issues-reached QCC involving many departments, it is better to ask for advice from chiefs of departments or leaders of the hospital.

Figure 3 Mechanism of outside participation for theme selection of QCC. QCC, quality control circle.




Conflicts of Interest: The authors have no conflicts of interest to declare.


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doi: 10.21037/jrh.2016.09.04
Cite this article as: Liu T, Zhang D, Jiang H. Problems and solutions of theme selection of China’s hospital quality control circle. J Res Hosp 2016;1:21.


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