Reflections on achieving organizational Quality

In a previous post, I commented on a “Notable Quote” printed in the ASQ’s November 2013  Quality Progress magazine.  It was reportedly a quote ascribed to Deming. 

Not entirely by coincidence, I was going through a number of books for our Certificate Course in Laboratory Quality Management and I came across a little book first published in 1996 entitled “Philip Crosby’s Reflections on Quality”.  It is basically a book of 295 quotations written and authored by Crosby.  I suspect by the very design of the book it was intended to be both a compilation of Crosby’s most influential comments on Quality and an homage to the book genre of the 1966 The Little Red Book: Quotations for Chairman Mao Tse-tung.  I mention this second point because while the two are in vastly different spheres, one can see common seeds between the Cultural Revolution and the Quality Revolution.  But that is a topic for a future posting.

What I want to focus on is Crosby’s absolutes, in particular his first “the definition of Quality is conformance to requirements”, his second “the system of Quality is prevention”, his third “the performance standard is zero defects” his fourth “the measurement of Quality is the price of non-conformance”.  

I was in a conversation with a colleague last week and the question came up about, at what point can you say that you truly run a Quality laboratory?  It is a fair question because we all tend to be goal oriented and labels are important.  

If I read Crosby as I think he intended, Crosby had a rather strict view on Quality and was that a Quality organization meets all requirements and has no defects or no nonconformities.  If that is a correct reading, I think that Crosby was of the opinion that the state of Quality is aspirational and a valued ideal, but is not truly or sustainably unachievable.  Quality is the ethereal end to the journey that begins with a single first step (homage to Confucius). 

I know that Crosby and Deming knew each other, but I don’t know if he had met James Reason, the expert on organizational error.  Current risk management is predicated on the concept that bad things happen, most often as the consequence of simple mistakes or distractions.  Many of these will be invisible or benign or seemingly innocuous but some of them will lead to very bad outcomes.  They are for all intents and purposes inevitable.  As long as we have working humans or machines, we will have defects.

But in today’s world recognition and public relations are important to organizations, especially in healthcare.  Top management needs to be able to point to evidence that their efforts to improve the organization are working.  Top management needs to be able to have some markers along the path to which they can honestly refer, and be able to say that the organization is moving well along the path to Quality and success.

So I present some markers that indicate they your organization is moving in the right direction, and at a certain point deserve to call yourself a Quality organization

1: A good start.
Perform your first Gap Analysis against your measureable goal, and develop a process by which you can and will close the gaps.

2: You are Making Progress.
Your first accreditation is always an achievement of which you can be pleased, but it is far more important what you do next.  The first is an achievement, the second is an accomplishment. The third is a demonstrated record.

3: Quality is your middle name.
You still have errors and defects, but now you have a system that detects them quickly and remediates their impact on your customers.  More importantly your system allows you to learn from your errors and put in corrective actions that make it unlikely that you will repeat that error.

4: Your name is Quality.
Your system works.  You know it works, your staff knows it works, your customers know it works, your colleagues know it works, your competition knows it works.  But you are still looking for continuous tweaks for improvement.

Allowing your staff to do their best

I was perusing my November 2013 copy of ASQ’s Quality Progress magazine and the article “Words to Work By” caught my eye.  Not so much an article, it was a collection of Quality quotes submitted by other readers.  Some were predictable (“Quality is never an accident…”) and some were pretty iffy (“There is more than one way to skin a cat … but it matters to the cat”).  

But there was one that caught my eye.  It was ascribed to Deming, and maybe that is true: ”It’s not enough to do your best.  You must first know what to do, and then do your best”.  

First off let me say that in a quick peruse of the internet, many ascribe the words to Deming, so I guess I will have to believe it.  But I also will say it is pretty inconsistent with his own 14 points, specifically the one about “eliminate slogans, exhortations and targets for the workforce” and the other about “remove barriers that rob people of pride of workmanship”.  Somehow I have my doubts.  What Deming probably said was something more like “if your worker’s best doesn’t measure up to what you expected or wanted, perhaps it is because you didn’t tell them what you wanted.”  Don’t blame the worker, look more closely at yourself.  

All my career I have seen folks write job descriptions which gets read, signed off, and then put in a file where is sits forever, provided that it doesn’t get lost.  The job changes over and over, but the document remains written in stone which progressively becomes as immutable as granite.  As new tasks come on stream, there may be efforts to train workers, but in many situations the process of learning is one of self-discovery.  

It seems to me that if our organizations wants people to know what they are supposed to be doing, so that they can then “do their best”, what we have to do is start seeing their job descriptions as living documents that documents each change that gets implemented.  

There are many advantages in ensuring that job descriptions remain current.  First, the description becomes the foundation for ensuring that appropriate training and confirmation and follow-up competency assessment occur.   Second, it becomes a foundation for task ownership.  Third it becomes the foundation for management to know what exactly they are expecting their staff to be responsible for.  Fourth it provides a foundation for ensuring that when the job becomes vacant, the next person in can be made aware of all the tasks they will be expected to address.   

Let me focus on one of the above foundation statements, specifically management awareness.  

Has this happened at your place?  It certainly has in mine.  Over time, the number of tasks required incrementally increases, commonly at a rate that is faster than revenue generation.  We can always hire more people, so we tack the new tasks on to existing personnel.  Research and development, or provision of new programs sometimes requires what seems to be just a few more hours per week to get a new service or program established; at least that is what you estimate.  But the task becomes a little bigger than you anticipated or takes longer than you thought.  Now your staff are incrementally busier than before.  Then another “small change” gets added in, and then another.  Nobody says anything, but after a while the signs of stress and distraction start to show up.  Mistakes start happening.  People seem angry, or worse, burned out.  All of a sudden, a key person quits.  Now you and your program are in trouble.  Unchecked persistent incremental change all too often leads to precipitous crisis.  

The problem wasn’t that people stopped doing their best; the problem was that you let the operation get out of control.  Management dropped the ball by not keeping an eye on what you were expecting of your staff.  

So here is the solution.  May sure that the job description is kept as a living document which is checked regularly and often.  If you know what you are asking people to be responsible for, and you monitor that list to ensure that it is feasible, then and only then can you count on your staff meeting expectations.

You hired your staff because you saw their strengths and merits.  Good management provides the opportunities that allow them prove your judgement and assessment was right.