DMADV is a process defined by Motorola as part of their Six Sigma management philosophy.

DMADV is applied to new processes to make sure that they achieve Six Sigma quality. Six Sigma sets extremely ambitious goals to minimize the occurrence of flaws in products and services. The letters in the abbreviation DMADV stand for "define, measure, analyze, design, verify," the steps in the ordered process. Those steps can be summarized as follows.

Define: State the problem, specify the customer set, identify the goals, and outline the target process. Measure: Decide what parameters need to be quantified, work out the best way to measure them, collect the necessary data, and carry out the measurements by experiment. Analyze: Identify performance goals and determine how process inputs are likely to affect process outputs. Design: Work out details, optimize the methods, run simulations if necessary, and plan for design verification. Verify: Check the design to be sure it was set up according to plan, conduct trials of the processes to make sure that they work, and begin production or sales.

The other Six Sigma process is called Sigma DMAIC, which stands for "define, measure, analyze, improve, control." This set of steps scrutinizes existing processes that are known to fall short of Six Sigma requirements. All Six Sigma processes are executed by Six Sigma experts designated according to "belt color," using a scheme similar to the ones used in martial arts.

Quality management for macro processes is carried out by use of the Juran Trilogy, which basically consists of three steps- Quality Planning, Quality Control and Quality Improvement. Let us understand the main activities and the relation between the three phases of the Juran Trilogy.

Quality Planning: The quality planning phase is the activity of developing products and processes to meet customers' needs. It deals with setting goals and establishing the means required to reach the goals. The various steps in the quality planning process are as below: Establishing quality goals Identify the customers- those who will be impacted by the efforts to meet the goals Determine the customers needs

Develop processes that are able to produce those product features Establish process controls, and transfer the resulting plans to the operating forces Quality Control: This process deals with the execution of plans and it includes monitoring operations so as to detect differences between actual performance and goals. It consists of three steps: 1. Evaluate actual quality performance 2. Compare actual performance to quality goals 3. Act on the difference Quality Improvement: The process is for obtaining breakthrough in quality performance, and it consists of several steps: 1. Establish the infrastructure needed to secure annual quality improvement 2. Identify the specific needs for improvement- the improvement projects 3. Establish project teams with clear responsibility for bringing the project to a successful conclusion 4. Provide the resources, motivation, and training needed by the teams to- Diagnose the cause, Stimulate establishment of remedies, and Establish controls to hold the gains. In most organizations there is a great focus on the Quality Control process, with little or no emphasis on the other two processes; however the well established and customer focused organizations do have clearly defined and robust process for all aspects of the Juan Trilogy. In my previous article on "Quality of Design" we discussed the importance of Quality Planning and its significance in the development of products and processes. Quality Control is an operational activity and the control part becomes easy if the planning process is robust, else the control process will remain only a firefighting exercise. In the control phase, statistical tools can be used to monitor and improve the processes involved. Some examples of control items are defects in products, response time to customers, billing accuracy etc. The Improvement process may typically call for cross functional teams at a macro process level and departmental teams at the micro level. The improvements could be reduction of rework or Cycle time reduction or elimination of any chronic quality issues.

The Juran Trilogy Diagram: The three processes of the trilogy are indicated in the diagram, which is a graph with time on the horizontal axis and cost of poor quality on the vertical axis. The planners are responsible for the product and process design to meet the customer needs; and the job of the operating forces is to run the process and produce the products. . We will see that the process cannot

achieve 100 percent quality and 20 percent rework has to be carried out. Quality control prevents from the situation getting worse and also putting off the fires such as the sporadic spike. In due course we will see that the chronic problems have come down by the application of the quality improvement process. The Alligator Analogy: The distinction between Quality Planning and Quality Improvement is brought out by the alligator analogy. This is a fable of a manager who is up to his waist in alligators; and each live alligator is a metaphor for chronic waste. Each completed quality improvement project results in a dead alligator and when all alligators are terminated the quality improvement is considered complete for the moment; but that doesn't happen as long as the quality planning process has not changed. A changed and improved planning process will only help complete improvement and sustain the same.From the trilogy diagram and the alligator analogy it is clear that quality improvement reduces quality issues but to sustain the new level there are to be improvement in the quality planning process.

What is it and how can it help me? You can use plan, do, study, act (PDSA) cycles to test an idea by temporarily trialling a change and assessing its impact. This approach is unusual in a healthcare setting because traditionally, new ideas are often introduced without sufficient testing. The four stages of the PDSA cycle: Plan - the change to be tested or implemented Do - carry out the test or change Study - data before and after the change and reflect on what was learned Act - plan the next change cycle or full implementation

Why test change before implementing it?

It involves less time, money and risk The process is a powerful tool for learning; from both ideas that work and those that don't It is safer and less disruptive for patients and staff Because people have been involved in testing and developing the ideas, there is often less resistance

When does it work best? You may not get the results you expect when making changes to your processes, so it is safer, and more effective to test out improvements on a small scale before implementing them across the board. Using PDSA cycles enables you to test out changes before wholesale implementation and gives stakeholders the opportunity to see if the proposed change will work. Using the PDSA cycle involves testing new change ideas on a small scale. For example:

Trying out a new way to make appointments for one consultant or one clinic Trying out a new patient information sheet with a selected group of patients before introducing the change to all clinics or patient groups By building on the learning from these test cycles in a structured way, you can put a new idea in place with greater chances of success

As with any change, ownership is key to implementing the improvement successfully. If you involve a range of colleagues in trying something out on a small scale before it is fully operational, you will reduce the barriers to change.