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Management Strategies to Facilitate
  Continual Quality Improvement



            John O’Neill
            Manager
            Quality Systems Division
            Boston Scientific Corporation
3 Point Strategy for Quality


Corporate culture embraces Quality

Continuous Communication & Improvement

Sustainability in mind at every stage
Quality Objectives

Quality is about the customer throughout the process.

Obtain customer requirements and feedback to
continuously improve while satisfying regulations,
standards and best practices.

Quality systems identify, measure, control, and
improve the parameters within each function.
Quality Culture

•   Management Responsibility
•   Strategy and Resources
•   Measurement and Analysis
•   Ensure Quality is Delivered
•   Feedback
•   Improvement
Organization
• Does Quality report to the CEO?

• Does Corporate Quality trump Business Unit Quality?

• Is Quality comparable throughout Units?

• Is “QA” available and empowered?

• Are the Quality Systems under QA?

• Are the Quality Systems linked and coordinated?
Quality Policy
•   Organization-wide Quality Policy
•   Short, Simple and Action oriented
•   Memorable
•   Ties the individual to Quality (ownership)
•   True
•   Utilized. examples:
       Cover Page, Footer, Badges, Posters,
       Wearing Apparel, Justifications
Partnerships
Quality should have aligned partners

   •   Regulatory Affairs
   •   Market Surveillance
   •   Information Technology
   •   Document Control
   •   Training
   •   Others
Quality Document Hierarchy
    Corporate Quality Policy

    Corporate Quality Manual

    Corporate Function Policies

    Corporate SOPs

    Corporate Work Instructions

    Corporate Knowledge-Sharing Documents

    Business Unit SOPs, WIs and KSDs
Critical Activities
Clearly map Requirements through Quality Systems
  links to business processes.

QA maintains appropriate alignment to the businesses,
 regions & functions it supports

Leverage the Corporate Quality Function and Field QA
  organization relationship.

Corporate Quality identifies and sets standards.

Business Unit Quality ensures compliance
Identify and Map Sub-Processes
What are the key sub-processes in the Quality
 Systems?

Example: Production & Process Controls may
  have several sub-Processes including:
  –   Validation
  –   Operations
  –   Equipment
  –   Facilities
  –   Testing
  –   Packaging
  –   Labeling
  –   Etc.
Ensure Quality input / feedback is
   integrated with each sub-process

Resulting in:

  Communication
  Coordination
  Compliance
  Complete implementation of objectives
Avenues of Dissemination
  Forums

  Team Meetings

  Site Visits

  E-Mail

  Power Point Tutorials
Risk Management
Risk Management is a distinct Corporate Quality Function

Each Quality System embraces Risk Management

Risk Management is well-defined and applied uniformly
  throughout the business units.

Each individual understands and applies Risk Management
  principles
The Importance of Metrics
Critical Inputs:
Investigation / CAPA timing & volume
Batch Specification Failures
Customer Complaints
Audit Findings / Repeat Findings
Late deliverables
Cost Over-runs
Missing Data
Missed- Training / Training Deadlines
Documentation
The Corporate Document Caretaker

Is assigned to all Corporate documents related to their designated
system. Owns the document process and is responsible for its
execution.


Knows the Documentation process and impact on Compliance,
Change Requests, Revision Timing, Training, and Communication
throughout the organization.


Ensures documents are compliant to all applicable regulations. Is
aware of connections to other processes and documents within
function and across functions.
Quality Document Changes
Caretaker:
Understands reason for change & ensure changes align with the process.
Obtains critical support.
Involves key individuals as appropriate.
Develops a viable update plan. Communicate: what, when, how, and why.
Checks for potential integration with other efforts.
Determines how the changes will be sustained.
Approver on every Change Request for documents governing their process.

User Community:
Reviews and assures that business units maintain alignment with the
corporate process whenever a corporate document is created or updated.
Document Change Management

Where feasible, a Caretaker can have a positive impact by
grouping, sequencing and timing changes to documents
pertaining to their quality system.

 Confirm the change is significant.

 Can a change be grouped with other changes and included in an annual
 update? Does it fit a designated criteria? (i.e. compliance impact, time
 period, category of change)

 When possible, non-compliance-related changes should be collected and
 implemented with compliance-related changes.
Audit Support
Is there an Audit Support Group?
Are Caretakers and SMEs audit-prepared?
Do findings and “close calls” get disseminated?
Is there a “Lessons Learned” follow-up?
Are Audit Metrics kept?
Is there Audit Training and Mock Audits?
Where do you put the accent in CAPA?
  Is it: CA’ PA, or is it: CA PA’ ?

  Are the number of timely completions rising?

  Is the “found effective” rate increasing?

  In the Mature Phase, are the PA’s growing and
  the CA’s shrinking?

  Is there an effective Feeder System?
Quality Teamwork
Sustainable Quality is built on collaboration & shared ownership.

   – Each quality system element may have a Corporate Caretaker,
     Business Unit Function Owner and community of Subject Matter
     Experts and Users in the business units.

   – The corporate quality system Caretaker is responsible for ensuring that
     their quality system is compliant. Users are responsible for their site’s
     compliance, stability and consistency.

   – There may also be Corporate Subject Matter Experts who provide
     support and guidance to Caretakers and Users as well.

   – Corporate Caretakers, SMEs, Site Process Owners, and Users work
     collaboratively to establish, sustain and improve quality.
Critical Players
Caretakers use their knowledge of the regulatory environment to
support the users by creating appropriate guidance, tools & templates for
those who execute Quality Systems. They collaborate with the users to
ensure their Quality System meets the regulations and business needs.


Subject Matter Experts provide the support and guidance
necessary to transfer expert knowledge and skill to others. Some sample
SME qualifications include:

 – Having technical training related to the subject matter and is qualified to train
   others.

 – Developer/Reviewer and/or previous experience with the subject area


 – Functional manager or supervisor responsible for the subject matter
Role of the Caretaker
Knows Function needs. Acts as Consultant / Facilitator for
continuous improvement .

Maintains awareness of ever changing standards, best
practices and enforcement of standards.

Ensures compliant processes, balancing compliance and risk.

Monitors compliance input from audits and shares knowledge
gained.

Utilizes Quality metrics. Ensures system measurements are
accurate and clear for management reviews.
Role of Caretaker
Remains proactive to problems; is collaborative, inclusive and
team oriented.

Enables users to own their local systems and execution as well
as improvement processes. Assists Users through process
improvements.

Builds a User Community. Promotes and practices extensive
communication, learning and inter-site networking.

Creates tools, templates and guidance documents.

Manages Document changes, training content and
implementation timing.
Caretakers are not…
overly prescriptive

focused only on the needs of one Business Unit

overly complicated in their approach

indifferent to Problems

indifferent to the User’s needs

process dictators / mandate-givers

disconnected from other Caretakers, especially if their
systems interact
Role of SME Community
Be an active & productive participant

Think globally
     Evaluate what might work at each site or all sites
Resolve issues & participate in projects
     Deliver on promises
     Be a Guide for change
Provide discussion on critical topics
     Keep discussions & debates positive
     Avoid diversions
Attend phone conferences and meetings
     For missed meetings, review meeting minutes for decisions and action items
Share information and best practices
     Volunteer to lead and disseminate site / function practices
     Communicate changes and progress through your business unit or function
Don’t monopolize forums and discussions
     Forums are venues to advance the organization and not dwell on business unit or
       professional agendas
Role of Process Owner

Serves as conduit for transmitting issues to
Quality and leading the implementation of
mutually derived improvements and
solutions.

Ensures the participation of the Users and
business unit Subject Matter Experts.
Continuous Improvement

Continuous Improvement takes place
through the partnership between Process
Owners and Caretakers. They lead the
development and implementation of large
scale efforts to enhance the Quality
System, ensuring improved compliance,
effectiveness and efficiency.
Role of Users
Users are the primary consumers of the
Quality System. They take the
requirements, tools and templates and
implement them in support of the
businesses, regions, sites, & functions.
They own the execution of the Quality
System and ensure compliance. Not all
Users are in a Quality Assurance function.
Caretaker / User Assessment
Monitor & report on the performance of the
organization to established standards and
expectations. Consolidate assessment
information for general use in organization.
Help to facilitate relationships and
communication with Third Parties.
(Contractors)
User Communities

A User Community is all of the participants in a
Quality System function who interact to better
understand, improve and execute their function.

The establishment, operation and success of
the User Community is the responsibility of the
Quality System Caretaker.
Role of the User Community
Provide a common avenue of communication and information

Synergistically network the members and functions of the Community

Serve as a forum for discussion of issues and best practices

Disseminate Audit-related findings, Regulations, Standards, etc.

Distribute information regarding new procedures and guidances

Proactively and continually improve Quality
Launching a User Community
Begin with SMEs, Project Teams, Training Lists & Document authors

Expand through word of mouth and mention at various Forums.

Initiate a User Forum to meet regularly, across business unit locations

Disseminate critical information; discuss useful topics & audit findings.

Engage all Users through invitations to contribute / present topics

Provide a QS function e-mail address monitored by Corp. Quality Group

Conduct periodic site visits / site Forum broadcasts to engage locally

Solicit feedback for improvement from participants
Sustaining a User Community
Maintain communications
       Establish SharePoint sites & folders
       Publish meeting agendas and minutes, Seek agenda items
         from the community
       Track Action Items to completion
       Use voting feature on e-mails for critical decisions. Communicate and
         review results.

Communicate attendance to keep business units engaged
       Review delegates to ensure that appropriate people are participating
       Contact those chronically absent.

Maintain consistent meeting timing and time commitments
       Inconsistent time and day of meeting discourages attendance
       Obtain consensus before changing time and date

Establish a method to track, prioritize, & time implementation
of changes in processes, automation & procedures.
Measuring Effectiveness
Forum Attendance

Number of Topic Contributors

Degree of participation in Forum Discussion

Number of phone calls / e-mails with questions

Adoption of community consensus for site action
Summary
Weave Quality into Corporate Fabric

Map Regulations and Standards to Functions

Establish Quality System Caretakers & User
  Communities

Build excellence into critical systems
(ex: Document Control)


Establish Quality Metrics to focus needs

Harness Feedback from Customers and Audits
Questions
• Why do you… ?

• How do you… ?

• Where would I find… ?

• What if we… ?

• Should I… ?

• Has anyone… ?
Thank You
IVT Participants

Boston Scientific
  Laura Owens
  Steve Thistle
  Marcus Gesner
  James Handzo
  Jacqueline Berretta

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Management Strategies to Facilitate Continual Quality Improvement

  • 1. Management Strategies to Facilitate Continual Quality Improvement John O’Neill Manager Quality Systems Division Boston Scientific Corporation
  • 2. 3 Point Strategy for Quality Corporate culture embraces Quality Continuous Communication & Improvement Sustainability in mind at every stage
  • 3. Quality Objectives Quality is about the customer throughout the process. Obtain customer requirements and feedback to continuously improve while satisfying regulations, standards and best practices. Quality systems identify, measure, control, and improve the parameters within each function.
  • 4. Quality Culture • Management Responsibility • Strategy and Resources • Measurement and Analysis • Ensure Quality is Delivered • Feedback • Improvement
  • 5. Organization • Does Quality report to the CEO? • Does Corporate Quality trump Business Unit Quality? • Is Quality comparable throughout Units? • Is “QA” available and empowered? • Are the Quality Systems under QA? • Are the Quality Systems linked and coordinated?
  • 6. Quality Policy • Organization-wide Quality Policy • Short, Simple and Action oriented • Memorable • Ties the individual to Quality (ownership) • True • Utilized. examples: Cover Page, Footer, Badges, Posters, Wearing Apparel, Justifications
  • 7. Partnerships Quality should have aligned partners • Regulatory Affairs • Market Surveillance • Information Technology • Document Control • Training • Others
  • 8. Quality Document Hierarchy Corporate Quality Policy Corporate Quality Manual Corporate Function Policies Corporate SOPs Corporate Work Instructions Corporate Knowledge-Sharing Documents Business Unit SOPs, WIs and KSDs
  • 9. Critical Activities Clearly map Requirements through Quality Systems links to business processes. QA maintains appropriate alignment to the businesses, regions & functions it supports Leverage the Corporate Quality Function and Field QA organization relationship. Corporate Quality identifies and sets standards. Business Unit Quality ensures compliance
  • 10. Identify and Map Sub-Processes What are the key sub-processes in the Quality Systems? Example: Production & Process Controls may have several sub-Processes including: – Validation – Operations – Equipment – Facilities – Testing – Packaging – Labeling – Etc.
  • 11. Ensure Quality input / feedback is integrated with each sub-process Resulting in: Communication Coordination Compliance Complete implementation of objectives
  • 12. Avenues of Dissemination Forums Team Meetings Site Visits E-Mail Power Point Tutorials
  • 13. Risk Management Risk Management is a distinct Corporate Quality Function Each Quality System embraces Risk Management Risk Management is well-defined and applied uniformly throughout the business units. Each individual understands and applies Risk Management principles
  • 14. The Importance of Metrics Critical Inputs: Investigation / CAPA timing & volume Batch Specification Failures Customer Complaints Audit Findings / Repeat Findings Late deliverables Cost Over-runs Missing Data Missed- Training / Training Deadlines
  • 15. Documentation The Corporate Document Caretaker Is assigned to all Corporate documents related to their designated system. Owns the document process and is responsible for its execution. Knows the Documentation process and impact on Compliance, Change Requests, Revision Timing, Training, and Communication throughout the organization. Ensures documents are compliant to all applicable regulations. Is aware of connections to other processes and documents within function and across functions.
  • 16. Quality Document Changes Caretaker: Understands reason for change & ensure changes align with the process. Obtains critical support. Involves key individuals as appropriate. Develops a viable update plan. Communicate: what, when, how, and why. Checks for potential integration with other efforts. Determines how the changes will be sustained. Approver on every Change Request for documents governing their process. User Community: Reviews and assures that business units maintain alignment with the corporate process whenever a corporate document is created or updated.
  • 17. Document Change Management Where feasible, a Caretaker can have a positive impact by grouping, sequencing and timing changes to documents pertaining to their quality system. Confirm the change is significant. Can a change be grouped with other changes and included in an annual update? Does it fit a designated criteria? (i.e. compliance impact, time period, category of change) When possible, non-compliance-related changes should be collected and implemented with compliance-related changes.
  • 18. Audit Support Is there an Audit Support Group? Are Caretakers and SMEs audit-prepared? Do findings and “close calls” get disseminated? Is there a “Lessons Learned” follow-up? Are Audit Metrics kept? Is there Audit Training and Mock Audits?
  • 19. Where do you put the accent in CAPA? Is it: CA’ PA, or is it: CA PA’ ? Are the number of timely completions rising? Is the “found effective” rate increasing? In the Mature Phase, are the PA’s growing and the CA’s shrinking? Is there an effective Feeder System?
  • 20. Quality Teamwork Sustainable Quality is built on collaboration & shared ownership. – Each quality system element may have a Corporate Caretaker, Business Unit Function Owner and community of Subject Matter Experts and Users in the business units. – The corporate quality system Caretaker is responsible for ensuring that their quality system is compliant. Users are responsible for their site’s compliance, stability and consistency. – There may also be Corporate Subject Matter Experts who provide support and guidance to Caretakers and Users as well. – Corporate Caretakers, SMEs, Site Process Owners, and Users work collaboratively to establish, sustain and improve quality.
  • 21. Critical Players Caretakers use their knowledge of the regulatory environment to support the users by creating appropriate guidance, tools & templates for those who execute Quality Systems. They collaborate with the users to ensure their Quality System meets the regulations and business needs. Subject Matter Experts provide the support and guidance necessary to transfer expert knowledge and skill to others. Some sample SME qualifications include: – Having technical training related to the subject matter and is qualified to train others. – Developer/Reviewer and/or previous experience with the subject area – Functional manager or supervisor responsible for the subject matter
  • 22. Role of the Caretaker Knows Function needs. Acts as Consultant / Facilitator for continuous improvement . Maintains awareness of ever changing standards, best practices and enforcement of standards. Ensures compliant processes, balancing compliance and risk. Monitors compliance input from audits and shares knowledge gained. Utilizes Quality metrics. Ensures system measurements are accurate and clear for management reviews.
  • 23. Role of Caretaker Remains proactive to problems; is collaborative, inclusive and team oriented. Enables users to own their local systems and execution as well as improvement processes. Assists Users through process improvements. Builds a User Community. Promotes and practices extensive communication, learning and inter-site networking. Creates tools, templates and guidance documents. Manages Document changes, training content and implementation timing.
  • 24. Caretakers are not… overly prescriptive focused only on the needs of one Business Unit overly complicated in their approach indifferent to Problems indifferent to the User’s needs process dictators / mandate-givers disconnected from other Caretakers, especially if their systems interact
  • 25. Role of SME Community Be an active & productive participant Think globally Evaluate what might work at each site or all sites Resolve issues & participate in projects Deliver on promises Be a Guide for change Provide discussion on critical topics Keep discussions & debates positive Avoid diversions Attend phone conferences and meetings For missed meetings, review meeting minutes for decisions and action items Share information and best practices Volunteer to lead and disseminate site / function practices Communicate changes and progress through your business unit or function Don’t monopolize forums and discussions Forums are venues to advance the organization and not dwell on business unit or professional agendas
  • 26. Role of Process Owner Serves as conduit for transmitting issues to Quality and leading the implementation of mutually derived improvements and solutions. Ensures the participation of the Users and business unit Subject Matter Experts.
  • 27. Continuous Improvement Continuous Improvement takes place through the partnership between Process Owners and Caretakers. They lead the development and implementation of large scale efforts to enhance the Quality System, ensuring improved compliance, effectiveness and efficiency.
  • 28. Role of Users Users are the primary consumers of the Quality System. They take the requirements, tools and templates and implement them in support of the businesses, regions, sites, & functions. They own the execution of the Quality System and ensure compliance. Not all Users are in a Quality Assurance function.
  • 29. Caretaker / User Assessment Monitor & report on the performance of the organization to established standards and expectations. Consolidate assessment information for general use in organization. Help to facilitate relationships and communication with Third Parties. (Contractors)
  • 30. User Communities A User Community is all of the participants in a Quality System function who interact to better understand, improve and execute their function. The establishment, operation and success of the User Community is the responsibility of the Quality System Caretaker.
  • 31. Role of the User Community Provide a common avenue of communication and information Synergistically network the members and functions of the Community Serve as a forum for discussion of issues and best practices Disseminate Audit-related findings, Regulations, Standards, etc. Distribute information regarding new procedures and guidances Proactively and continually improve Quality
  • 32. Launching a User Community Begin with SMEs, Project Teams, Training Lists & Document authors Expand through word of mouth and mention at various Forums. Initiate a User Forum to meet regularly, across business unit locations Disseminate critical information; discuss useful topics & audit findings. Engage all Users through invitations to contribute / present topics Provide a QS function e-mail address monitored by Corp. Quality Group Conduct periodic site visits / site Forum broadcasts to engage locally Solicit feedback for improvement from participants
  • 33. Sustaining a User Community Maintain communications Establish SharePoint sites & folders Publish meeting agendas and minutes, Seek agenda items from the community Track Action Items to completion Use voting feature on e-mails for critical decisions. Communicate and review results. Communicate attendance to keep business units engaged Review delegates to ensure that appropriate people are participating Contact those chronically absent. Maintain consistent meeting timing and time commitments Inconsistent time and day of meeting discourages attendance Obtain consensus before changing time and date Establish a method to track, prioritize, & time implementation of changes in processes, automation & procedures.
  • 34. Measuring Effectiveness Forum Attendance Number of Topic Contributors Degree of participation in Forum Discussion Number of phone calls / e-mails with questions Adoption of community consensus for site action
  • 35. Summary Weave Quality into Corporate Fabric Map Regulations and Standards to Functions Establish Quality System Caretakers & User Communities Build excellence into critical systems (ex: Document Control) Establish Quality Metrics to focus needs Harness Feedback from Customers and Audits
  • 36. Questions • Why do you… ? • How do you… ? • Where would I find… ? • What if we… ? • Should I… ? • Has anyone… ?
  • 37. Thank You IVT Participants Boston Scientific Laura Owens Steve Thistle Marcus Gesner James Handzo Jacqueline Berretta