Is this an oxymoron? Well,
it kind of depends on how you define “quality” and who your customers are. I work in the Office of Medical Services of
the Department of State (DOS). One
customer group we deal with is DOS employees who want to serve overseas. Our other customer group consists of job applicants
with some medical condition that may prevent them from being hired.
Those in the employee group have little clout as individuals,
but as a group they are potent. If
enough of them become unhappy with our services, a directive comes down from
above to “FIX THIS PROBLEM!!” Once we
understand what excites senior management, we fix that problem. And then we fix it again, until it is so
slick, we get kudos from customers.
The applicant group is less powerful. Some write their Congressman, and that gets
attention tho not usually the desired result.
Some hire lawyers. Again,
attention but not usually the desired result.
And then, a funny thing happened. Five years ago, we adopted ISO 9001 as a
management system. Now, each of the 30+
sub-processes in MED has a written procedure about how they do what they
do. They know who their customers are and
actively solicit input. The most common
metric is clock time, and “stuff happens faster now.” (A quote from an employee
survey.) One process in my office that
routinely took 60 to 90 days now gets done routinely in 2 to 4 hours. A few years ago, it took, on average, 11 months
to hire a new employee. Last month, we
interviewed an applicant who applied only two months ago.
If this still seems long to you, you’ve never dealt with OPM
or applied for a Federal job. If you do
so, the person who wants to hire you may never see your application. Some clerk in HR, who knows nothing about the
job will decide how well qualified you are.
The office that has the opening will only see the top three names on her
list. For the rest, it’s a coin toss.
Are we truly worse that the civilian healthcare industry, as
Paul
Borawski suggests? No. We’re better, and I can prove it. We collect HEDIS data every month from each
of our 180 primary care offices around the world. (Now there’s a challenge!) Three times a year, we compare our data to
the best US healthcare system results and discuss improvement strategies at the
senior management level. In general, we
do well, although there are some special challenges in our system. (Like getting a frozen vaccine to
Ulaanbaatar.) One thing we have that
makes all this work is a culture of quality—the universal desire to do a good
job coupled with the knowledge that senior management shares that goal. Each quarter, we discuss errors, deaths, and
complaints with those providers stationed in Washington. I once received this email from a medical
officer overseas: “Bob, we made the following mistake in our health unit this
week. Please discuss it at your next
meeting. I’d like to see what the group
thinks.”
How do you get there?
It takes leadership, consistency, and credibility. It can be done in government.
