The Culture Quality Interface

The Culture Quality interface

Culture and Quality has been a long-time interest of mine.  I have stated with total certainty that an organization needs to have a palpable Culture of Quality in order to succeed in Quality Improvement. 

I still believe that to be an absolute truth, although I have moved a little bit from the absoluteness of the statement.  Today I am more comfortable with the saying that having a Culture that supports Quality may or may not lead to significant improvements in Quality Improvement, but if the acceptance and interest in Quality is NOT there (i.e. if there is no Culture of Quality) there is absolutely no chance to creating any lasting Quality Improvements.  

Said another way, even if everyone sees the value and importance of Quality, improvements may not last because financial, or changing dynamics, or other interferences get in the way.  But with absolute certainty, if no one in the organization gives a damn, the likelihood of improvement is not only zero, the greatest expectation will be that more errors will occur, staff will be more indifferent and whatever level of Quality there is, will get worse.  It is stunning how often we see that in action. 

So understanding Culture is essential and integral to implementing Quality Improvement.  

With that in mind, the last few days have been really enlightening for me because I was able to change out of my teaching and investigation mode and became a student by taking a course in culture improvement.  The centerpiece of the course was exploring the Organizational Culture Assessment Instrument (OCAI) which can be used to define and characterize the competing values of culture types.

The course was given by Marcella Bremer who lives in The Netherlands and is a major player in the international community of Culture improvement. 

The course was just what I needed; away from the office and intrusions for 3 days and the opportunity to focus.   Most participants were consultants from across 5 continents wanting to explore and dabble in OCAI.  I also met a kindred spirit; a person working in another university setting and struggling with all the same issues that I also have to deal with, and maybe worse.  

Without going into too much detail, the developers of OCAI were deeply interested in the nature and personality of organizations (all organizations) and studied many cultural characteristics.  Through comparative analysis, they were able to weed down to 4 major personality influencers and types: 

Hierarchy

the processes that bring order and CONTROL to an organization such as standards and guidelines, top down management, process and procedure, quality control, accreditation etc.

Clan

The processes that bring collective COOPERATION to an organization such as staff engagement, kaizen, etc.

Adhocracy

The processes that bring CREATION to an organization such as research and development, new programs, new methods, new strategies, etc.

Market

The processes that lead to COMPETITION such as methods that increase market share such as market strategy, market growth, customer satisfaction.  (note:  in healthcare, there are elements of competition that exist such as wanting to find more patients, or more studies or more grants, but mostly what we are try to focus on is more and better satisfaction).

What is, or should be intuitively obvious, is that each of these elements is essential and the choice is not one of exclusion, but of balance.  Sometimes an organization’s improvement needs a little more top-down support.  Other times the opposite may be what needs to happen.

We spent little time talking abut the OCAI itself (it is after all only one management tool), and much more on what organizations can do if they believe there is room for culture adjustment and how the information within OCAI results can give some guidance.  What is pretty clear, is that (a) it is not as easy as snapping your fingers and (b) it can be a lot more straight forward and not as hopeless that you fear it might be.  I left with some definite ideas how I could make things happen.  

For me, this time away from the office was a total success; what could be better than getting to spend 3 days with people pretty much of like mind exploring new thoughts and new ideas.  

But as I said at the beginning, strengthening a laboratory’s collective culture and interest in Quality Improvement does not guarantee there will be success.  But doing nothing will assure that improvement efforts will not lead to success, and more importantly, will either remain static, or slide down the pipe to more error and failure. 

 

What a choice!!

Not GB Shaw but still a quality prophet

Not George Bernard Shaw – but still a Quality Prophet.

I have always been a Quality fan of Philip Crosby.  He was a hands-on qualitist (one who practices Quality) and qualitologist (one who studies Quality) with a lot of experience.  Crosby became a skilled speaker and writer and learned how to make essential points clearly and succinctly.  

His 4 absolutes have defined the universe of Quality in a way that has never been surpassed.

The DEFINITION of Quality is meeting of requirements (of both customer and process).

The SYSTEM (PURPOSE) of Quality is the prevention of error.

The PERFORMANCE STANDARD of Quality is Zero Defects (relative to both the customer and process).

The MEASURE OF Quality is the Price of Non-conformance.

I regret that by the time that I got really engaged in Quality he was doing more writing and less public speaking and passed away a short time later.  I would have loved to have shared a brew-or-two.

I was always interested in knowing if he had the opportunity to re-write DIRFT (do it right the first time) if we would have developed an alternative phraseology  that would have retained the message but softened the tone.

Actually I think he would have looked at me, shook his head and walked away, probably saying something about my total absence of any real competence or commitment (In Reflections on Quality he doubled-down with “the thought of error being inevitable is a self fulfilling prophesy.  If you think it has to be that way, it will be that way”)

On a related note, I was flipping through Google, as I am preparing for a series of presentations, and I came upon the affirmation, “Success is not about never making a mistake; success is not making the same mistake twice”.  It was ascribed to George Bernard Shaw, the famed Irish author.  I have always been attuned to that philosophy as the true extension of the four absolutes; learn from your mistakes and you will prevent the error next time.

I have learned that a lot of affirmations are nice words, but too often mis-ascribed or maybe even made up (Albert Einstein never said that bochum about the cause of insanity.) so I was a little concerned that I couldn’t find any reference to a GB Shaw play or lecture.  

 But I did find something even more important.

George Burnard Shaw never talked about success and blunders, but Henry Wheeler Shaw did, and wrote it in one of his books “The Complete Works of Josh Billings” and first published the phrase in another book in 1865.  (George Bernard Shaw did not start his writing career until 1884!)  

HW was born in Massachusetts the son, nephew and cousin of American congressmen.  He was a pretty good student until he got thrown out of school for pulling a prank (Yay!!). 

He made his career similar to his countryman Samuel Langhorne Clemens, including the creation of a pseudonym; Clemens became Mark Twain, and Shaw became Josh Billings.  Both were itinerant actors, humorists, authors on a range of topics from a down-home common-sense perspective.  “Success don’t consist in never making blunders, but in never making the same one the second time”.  He is also the guy who wrote in a poem that it is the “squeaky wheel that gets the grease”.

To put this in some sort of temporal perspective, Josh Billings predated Crosby, Juran, Deming, Shewhart, Ford and even Frederick Winslow Taylor.  So I guess that makes him some sort of Quality Prophet.  

From my perspective what makes Josh Billings so important to the Quality movement was that he was not an industrialist, not a qualitist, and not a qualitologist.  He was well-read and well-written, thoughtful everyday person  voicing some pretty important quality concepts from a common-sense perspective.

The message is clear; Quality is not something elite; it can be founded first in common sense and plain language, and, if you read some of “Josh Billings; Hiz Sayings” in humor. 

You can get this book through Amazon for 91 cents!!!

As a final note, there are lots of people who love affirmations, and love to buy those plaques and put them on their office walls as inspirational.  Just be aware than just because someone ascribes the words to some famous person, doesn’t necessarily mean those words came from that mouth or were framed in that brain.  If that doesn’t matter that is OK, but if you are more verification oriented, a little more checking may be appropriate.