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.