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.