Thursday, March 22, 2012

Q For Sale

What is this “quality” that we’re being asked to sell?  Using the word as a noun implies that it is concrete—a product that you can package and put on the shelf.  “I’ll have three pounds of quality, please.”  More frequently, it’s used as an adjective, as in “quality service” or “quality products.”  It’s common to see a mission statement profess to provide “The highest quality healthcare,” whatever that means. 

The term has become a slang expression, having no intrinsic meaning, and some organizations have dropped it.  “Quality” appears only once in a footnote on the Baldrige Award web site.  The American Society for Quality is now known as ASQ, and you won’t find a translation of those letters on their web site.  It is possible to go thru the ISO 9001 standards and remove the word “quality” entirely, without altering the meaning of any sentence. 

So then, what is it we’re being asked to sell?  What does “quality” look like, and why would anyone spend good money for it?  Perhaps it is an ethereal concept that we can sense or feel but cannot define.  More likely, it is an aspect of organizational culture, relating back to the concept of Total Quality Management.  Every employee has a compulsion to do whatever they do better than anyone else, anywhere.  But that’s not enough.  Employees must perform together to provide a service or product that is best in class.  But even that’s not enough.  They must do this reliably, every day, as a habit.  “This is how we do things here.” 

More than once, a Baldrige Award winner has been asked, “You just won this nice award, but what are you going to do on Monday, when you go home?”  Without exception, the astonished CEOs have replied, “We’ll do what we always do on Mondays. This is who we are.”

So, back to the original question: What is it that we’re selling? A concept?  Well no, it’s more like a culture.  Can you sell culture?  Can you impose a culture as an outside consultant?  No to both, but you can help senior management change the culture in their organization, assuming they see the benefits in doing so.  And that’s something we can sell.  AHRQ and others have demonstrated that you can create or improve a patient safety culture.  You can, of course have both—a safety culture and a quality culture.  They are not incompatible, but they are also not identical.  In either case, you have to work at it.  As Paul’s quote from Deming implies, “Success is not guaranteed.”  I like the quote from Paloma Herera (see last month), “First you must have a passion.  Then you must work very hard.”  That’s a formula for success in almost anything. 

Wednesday, March 7, 2012


Paul Borawski asks why students aren’t flocking to Science, Technology, Engineering, and Math (STEM) as career fields.  The responses and his analysis focus mainly on how to improve the educational process in these fields.  Maybe it’s time to do a root cause analysis and a contrarian analysis of why anyone studies STEM, or anything else.

First guess is money.  People study fields where they can make money.  Yes, some do.  And many are happy doing that, tho 2008 brought a sobering reappraisal of careers in banking and finance.  However, salary is not on every employee’s top five list, and not every medical student wants to be an orthopedic surgeon.  For most people, once you make enough money, more is not a sufficient attraction to do something you don’t like.

Family tradition figures prominently but again not an invariable indicator.  If you grow up in the industry and hear conversations at the dinner table, you will at least have an interest in the field.
Talent or genetic predisposition is important in music, art, acting, etc.  Math and engineering; perhaps.  I’ll put personality into this category:”I like doing things that this field requires.”
Passion.  An inspirational teacher or mentor may be enough to create a college major and perhaps launch a career.   Some months ago, a young girl asked ballerina Paloma Herera for the secret to becoming a good dancer.  “There is no secret,” she replied.  “You have to have a passion, and then you have to work very hard.” So passion is required, but it’s not enough.
To some extent, we need to differentiate between a career and a hobby.  I know many people who are good at music or art but don’t depend on those skills for their income.

All of the above factors may push a student toward STEM, but what about the attractive factors that attract him to those fields?  On a survey, State Department employees checked that they identified with our mission and felt that they were making a positive contribution.  Meaningful work that is appreciated—but not very much.  Anyone want to be a Federal employee today?  Maligned and attacked almost daily.  Salary stagnant, and future benefits in doubt. 

OK, what about the STEM fields.  Are Science and Technology respected and valued?  When science says the world is getting warmer because of the release of CO2 by humans, does Congress respond with a carbon tax and other measures to reduce the burning of fossil fuels?  Do we embrace the science of stem cell research to relieve the disease burden of man?  When engineers (including quality professionals) offer tools and techniques to improve the efficiency of  healthcare services and thereby reduce costs, do we implement their advice?  In short, are STEM fields valued and respected in our society?  If not, how can we expect to attract students to careers where their scholarship is denigrated and their advice ignored?

What can we do?  One easy answer is to appoint and elect individuals who do respect STEM to positions responsibility.  Make that a litmus test for politicians: “If science dictates a politically unpopular stance, how would you vote?”  Blind acceptance is not required, but the facts cannot be denied out of hand.  Decisions must be made by rational process that conveys a message of respect for the STEM fields.  Then, students with the requisite talents and inclination will be attracted to fields where they can make a meaningful contribution to society.