Friday, June 22, 2012


In his 7 Jun posting, Paul Borawski asks whether “quality” is more related to the product/service or to the organization as a whole.  In his speculation, he references a report written by an ASQ Board member for The Conference Board.  The Quality Council of The Conference Board opines that Quality is not merely a set of tools, but they’re a little unsure about what the alternative is. 

The subject of the paper is ostensibly what CEOs are thinking about, but most of the discussion centers on how to achieve excellence in the areas under discussion.  How do you “create a culture of innovation?”  How do you achieve “Global expansion” without over extending.  Human Capital is a perennial problem—how do you get the best employees and then get the best out of the employees you have? 

 Is any of this relevant to healthcare?  Does anyone on the sharp end of healthcare care about innovation?  Global expansion?  Human capital?  Without any real competition—particularly price competition, there is little serious interest, and we even seem to be getting less competitive, as major players stake out spheres of influence.

Whither “quality” in healthcare?  If it’s not a set of tools or techniques, what does quality look like in healthcare?  Part of the answer comes in one of the strategies from the Conference Board under Innovation: “Create a culture of innovation . . . .”  In a comment on Paul Borawski’s original blog, Mike Alumbaugh refers to an “excellence centric culture.”  So what’s a culture anyway?  And how does it relate to quality (whatever that is!).  Think of culture as “a collection of beliefs shared by a defined population.”  Think for a moment, if everyone in your organization worked every day to do whatever they do better than anyone anywhere.  Congratulations.  Assuming you define “quality” as doing something really well, you have just created a quality culture.  Everyone in the organization shares the belief that quality is important.  They know the CEO believes it is important, so quality is now a culture, and employees will work to further that goal. 

Some years ago, I was standing on the deck of the Queen Mary 2.  Three senior officers came thru a door onto the deck near me, and as they did so, one of them bent over to scoop up a scrap of paper from the deck.  Why did she do that?  Cleaning the deck was not her job!  But, yes, it really was her job.  Keeping a neat ship was part of their culture, so of course she would pick up a stray scrap of paper, as would any other employee.

A patient’s family wrote me a thank you note after one of our employees changed a flat tire so the departing patient wouldn’t have to wait for the repair truck.  I knew nothing about this but I wasn’t surprised.  It was consistent with our culture of providing exemplary service—of course he would change the flat tire and not regard that as anything special.  That’s what culture does for you—shared beliefs.  Of course the nurse would make her intake visit in the parking lot, so mom wouldn’t have to awaken her sleeping child. That's what we do here.

You can define “quality” any way you want.  It can mean excellence in customer service.  It can mean cost effective care.  It can mean all of the above or other things.  The only trick is getting employees to share that definition.  That’s leadership. The end result is a culture of quality in the organization.  Tools may be useful and used, but it is the pervasive culture that defines quality in the organization.   A collection of beliefs in a defined population.  

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