Chapter 17 – The Management & Control of Quality
Case 17-2: Kelsey Hospital
The purpose of this case is to have students analyze and categorize costs of quality (COQ) in a nonprofit
health care setting. The case describes the need for a quality costing system in a hospital and the
development of such a system for two primary treatments (intubation and bronchodilator treatments)
performed in the Respiratory Therapy Department of the hospital. A list of items pertaining to quality
costs is presented and described for analysis, estimation, and categorization.
Teaching Notes
In recent years, companies have realized that to be globally competitive, they must focus on the quality of
their products and services. Traditionally, the costs relating to quality have been buried in other cost
categories (i.e., administrative overhead). To evaluate the costs and benefits of efforts to enhance quality
and also to better control costs relating to quality, the quality costs need to be segregated and properly
measured. Therefore, many companies have established cost of quality systems. Cost classification is an
important aspect of these systems because different categories are controlled differently, some categories
are more serious in terms of future consequences than others, and investment in certain categories is
believed to greatly reduce those in other categories.
Determining and measuring costs of quality in a service organization are especially challenging.
Manufacturing companies can inspect their products before delivery to customers and quality can be
assessed visually or by the use of instruments. In contrast, service organizations cannot assess quality until
after the service is rendered and measuring instruments are usually of no use because physical
measurements are not applicable. Hence, it is much more difficult to determine and measure the costs of
quality in a service organization than in a manufacturing firm.
Manufacturing cost of quality cases have been written in settings such as electronics1 and paper mills.2 The
issues covered in these manufacturing cases are similar to those in the Kelsey Hospital case study, but how
the costs are determined and measured in the service setting are more complex. With products, one can
assess the quality of materials, the quality of product design, and the conformance to product
specifications. In service settings, however, one is usually assessing quality associated with intangible
items, making it a more nebulous exercise to measure quality costs.
At least one service case exists in the context of a railroad3 and involves the use of quality costs relating to
environmental management. Kelsey Hospital also differs from most other manufacturing and service
settings in that consideration needs to be given to quality perceptions of an outside customer group–third
party payers. Furthermore, because health care organizations deal with human lives, quality is even more
paramount than in most other types of organizations.
The Kelsey Hospital case involves the analysis and categorization of quality costs in a nonprofit service
setting. The case is based on an actual hospital’s experience with developing a cost of quality program,
although all names in the case are fictional. The case largely involves opinionated discussion. The learning
objectives for the case are as follows:
1 Examples are: Signetics Corporation: Implementing a Quality Improvement Program (A), Stanford University,
1982; Texas Instruments: Cost of Quality (A), Harvard Business School, 1988.
2 Iron River Paper Mill, in Anthony, R. N. and V. Govindarajan, Management Control Systems, Irwin/McGraw-Hill,
1998, pp. 646-655.
3 Union Pacific Railroad: Using Cost of Quality in Environmental Management, Institute of Management
Accountants (IMA), 1997.
17-9
Education.