Thursday, January 31, 2013


OMG!  (I think that translates to "Oh my goodness.")  According to an ASQ survey, 81% of parents are "uncomfortable if their child does not perform well in sports."  Glad my parents didn't read that when I was a kid.  I learned early on that I was not good in sports--any sports.  You don't want me on your team.  Fortunately, it never bothered me (or my parents).  A slightly smaller percentage of parents were distressed over their children's bad grades, so success in sports is a little more important than academic excellence.  That's hardly surprising when you compare the salaries of high school dropouts who play football with college professors.

What about healthcare? For their part, students cited a fear of failing as a reason not to take STEM courses.  OMG.  How else do you establish your place in the world and learn what you're good at?  And where is it written that you have to be good in STEM subjects to have a career in healthcare! Success after failure requires dedication--some might say passion.  Yes, I'd say that.  I failed my first test when I was about 10, an external exam in Morse code. Decided that I didn't really care about Morse code and never looked back.  Later, I failed the first test I took in college: French. But that was something I did care about, and four years later, I toured France for a month and spoke only French. 
ASQ frames this is the sense of hesitancy to take risks because of fear of failure.  This, of course, is the reason one company has an award for failure.  The thinking is that if you're afraid of failure, you'll never try anything, and the company will miss opportunities. 

All of this assumes that failure and success are black and white dichotomous issues.  This is rarely the case.  We have all made decisions that didn't turn out well.  We reached the destination, but it took a little more time/gas to get there.   I can also recall some unexpected successes on trying out wild and improbable ideas.  Akin to disruptive innovation. 

How do we change this thinking in parents?  Children (even adult children) must be allowed to fail and to know that we still love them.  It's OK to fail.  Fast forward now to a healthcare environment.  As a manager/CEO, you must be able to say (to yourself), "That sounds like a really terrible idea, but if you want to try, have at it."  The employee hears only the part after "but."  That's another way of saying, "I support you in this.  Win or lose, I'm with you."  It's important to be able to say that even when you think it's a terrible idea.  Did she ask your opinion?  Did you ask how she planned to dodge this or that sinkhole? 

There is an unsubstantiated quote from a famous leader: "If you succeed, the glory will be yours.  If you fail, the responsibility is mine" (because I knew what you were doing and allowed you to proceed).  The corollary must always be, "in either case, we still love you."  I'm thinking of Little League parents.  Some years ago, "empowerment" was an au currant concept, and it's the same thing. Give employees (and children) the power to make decisions--even bad ones, and be there to catch them when they fall.  Remember, you're not always right.

Maybe we need to change our culture to re-define success and failure, so we are more tolerant of ideas that don't work out as anticipated.  Teddy Roosevelt once defined happiness as "working hard at work worth doing."  I also like Paloma Herrera's advice on becoming a successful ballerina: "First you must have a passion.  Then you must work very hard."  Neither philosophy excludes failure.  Neither requires that every endeavor be successful.  Indeed, for TR, success is achieved by working hard. 

There is, of course, another side to this.  If you failed every math test you ever took, it's probably not a good idea to go to engineering school.  However, you only learn that by taking risks and being willing to fail.  In this case, "failure" means better defining where your strengths lie.

Next week, I'm taking a risk.  I'm starting a class in digital media at the Corcoran Art School with a bunch of art majors who will be about one third my age.  This may not go well, and I hope that's OK with everyone.

Thursday, January 3, 2013

New Thoughts

In his 3 Jan blog, Paul Borawski asks again about definitions of quality and mentions again the ASQ study on the future of "quality."
So, I read it again, more carefully this time.  Buried in this paper is an essay by Roberto Saco, a past president of ASQ, in which he defines three definitions or levels of quality.  The first is found at employee-customer interface, the processes that create the products or services your customers require.  Here, we define quality as meeting specifications, satisfying customer needs, etc.  Here, we employ those tools and techniques that are near and dear.  But, in addition to looking outward at customers, our employees must look up at the company itself and be good stewards of company resources.  Meet those specifications in an economically viable manner, so the company can continue to exist.  Finally, the company itself needs to define quality in its relationship with the community.  

I once laughed at a hospital's mission statement than included "improving the health of the community."  But maybe that is appropriate in the context of this third aspect of quality.   I read recently that the burning of medical waste by hospitals is a significant contributor to air pollution.  Maybe the third level of quality could include taking care of the environment.  I  once visited a surgery center that used batteries for emergency power, rather that the traditional generator.  When they turned on their emergency power, there was no diesel exhaust.  Like so many things, once you decide to do it, the ideas are endless. 

In a previous post, I argued that the "quality" had become a slang term and thus had no precise meaning.  Mr. Saco is suggesting that there are three definitions, or aspects where different specifics apply.  For front line employees, quality means satisfying customers by meeting their needs, even unexpressed needs.  If a nurse sees a patient clutching a blanket in the pre-op area, she calls the engineers to raise the room temperature and then arranges for the temperature to alway stay at the warmer level, so no patient will ever again feel cold there.  That's quality. 

Looking upward, that same nurse will point out that a warmer room temperature will obviate the need for a blanket warmer in her area and also reduce the laundry bill.  Her simple action will thus increase the profit margin for the hospital in day-surgery.  That's quality at the second level. 

By not running that blanket warmer, the hospital just reduced its demand for electricity from the coal fired utility, thus improving the air quality in the community.  OK, it's a small thing, but, as they say, one starfish at a time.  (Yes, it's cheaper to warm the room rather than run the blanket warmer! Besides, cold patients require multiple blankets.) 

But we still don't have a single, unifying definition of quality.  Here's where I think Roberto and I would agree: You take a broad, general definition and supply the details at each level.  Let's take my favorite, from Lexus: "The relentless pursuit of perfection"  and apply that in a hospital from the day surgery unit to the board room:
1. and 2. We run a LEAN and mean operation in Day Surgery (excuse the pun).  Our processes of care are constantly examined to eliminate waste of time and materials.  There are no cupboards in our ORs, so the only supplies in the room are those we need for that case.  Our surgeons who repair hernias have agreed to use the same instruments and supplies, so we prepackage those kits.  This helps make our room turnover practically instantaneous.  Mop the floor, empty the trash, and we're ready.  All our surgeons use local anesthetics at the end, so there is minimal pain in the recovery room.  Our anesthesiologists utilize regional anesthesia to further reduce problems in the recovery phase.  Surgeons love the efficient way we move their cases along.  Patients love the stress-free process and our smiling faces everywhere.  The hospital likes our low internal costs, although we're always looking to improve that.  Our employees love working here.  We're the first team!  (No one has ever left.)

3. The hospital partners with local industry and the community at large in sponsoring a recycling program that also presses suppliers to reduce waste in packaging.  This has become part of our culture, so you just don't see soda cans in the trash here.   Vegetable scraps from our kitchen go into a giant worm bin, and the output goes to local truck farmers who grow veggies for the hospital kitchen.  We have also worked with the Mayor to secure a commitment to build a trash-to-electricity plant where all community trash will be burned to make steam and electricity.  The temperature is hot enough to allow including our medical waste in this process also.  Methane from the local sewage treatment plant will feed into this process, but the details are pending.  Our parking lot is shaded by solar photo-voltaic cells that produce about 25% of our power requirements.   

See, isn't it fun!  The more you think about these things the better it gets.  Don't forget, you have to involve ALL employees in this "Pursuit of Perfection."  That's leadership. But it's also fun.  Employees like to be included.

Last week, I was checking out at the supermarket, and the clerk was interrupted to page someone over the intercom.  "I just love it when I get to do that." She said.  "It makes me feel important."  I quickly assured her that she was indeed important--perhaps the most important person in the store, because she worked at the sharp edge of the enterprise, the place where I decide if I'm ever coming back again.  Probably more than she wanted to hear, but she did pause to consider the concept, and I felt good about pointing it out. My wife just rolled her eyes.