By Ben Locwin, Ph.D.
This article was intended to be the last installment in Identifying And Resolving Errors, Defects, And Problems Within Your Organization — a five-part series on operationalizing proper improvement techniques. However, my editor objected to the length of my draft, so we decided to split it in two. Hence, what you are reading is now Part 5 in a six-part series, or Part 5a in what is still a five-part series — however you choose to view it.
Why does “Quality” seem like such a slippery, elusive term? The answer is easy: It’s because the people who claim to know it really don’t. And everyone else is exhibiting a form of the psychological bias known as the bandwagon effect, in which they go along with the rhetoric because everyone else is.
How often do you hear physicists arguing about “what” Newton’s second law of motion means? Or disagreeing about what’s important when describing the tidal forces of the moon on the earth? You don’t hear of such things because there are accepted bases for what “knowing” physics entails, and that includes the formal rigor of the mathematical tools of “doing” physics and the empirical evidence that has been gathered. But if you put 137 Quality professionals in a room, you’ll hear at least 136 different opinions about how to interpret Quality or the regulations pertaining to healthcare quality. (I not-very-arbitrarily chose this number because it’s the denominator of the Fine Structure Constant (1/137), and so a lone quality presence in an audience such as this will basically have the same overall influence on the group as the power of the FSC.)
If this is your launching point for this series, each of the previous articles are easily available to you here:
Slogans, Slogans Everywhere … But Does Anybody Really Understand Them — Or Care?
We commonly see slogans such as “Quality is Job 1” (Ford), “Quality never goes out of style.” (Levi’s), etc.
But Quality can’t be “Job 1” if you don’t know what Quality is. And no, you can’t just know it when you see it. Quality should be a repeatable set of approaches to systematically identify the systemic causes of issues, resolve them so that they no longer have an influence (or have their influence minimized) on your processes’ outputs, and continuously improve both your ability to measure and also to influence your systems and processes.
Quality guru W. Edwards Deming had a real visceral problem with Quality slogans, and encouragement or admonishment posters within companies (“strive for this,” “work harder for that,” etc.). He felt this way because he understood what was going on not only within the calculus of Quality, but also within the structures and behaviors of organizations. Telling people — anybody — to work harder, especially demoralized staff, is about the fastest way to ensure regrettable turnover (i.e., “employees quitting,” for the non-HR readers).
Deming would often say, “A bad system will defeat a good person every time,” which is true. I’ll follow this up with another of Peter Drucker’s thoughts on this, which was “Culture eats strategy for breakfast.” Read that quote again. If you put people in a bad system, and you have a toxic culture, it doesn’t matter how heavy you wield the hammer — your company is irrevocably broken.
Whatever You Do, DON’T Pick A Red Bead
I’m going to put all this in context within the guise of Deming’s famous red bead experiment. Here’s how it goes: You take a group of employees, say five of them, and gather them at a table. In the center of the table, you have a bin full of beads. Most of them are white, but 20 percent are red.
Now you divvy up organizational roles to each of the participants, including a foreperson (supervisor), a QC analyst, and an operator. The operator gets to wield a sifting scoop, which is designed to capture 25 (or 50) beads from the bin at random. To QC checker does what QC checkers do, and … checks the result. The supervisor admonishes — or encourages — as supervisors are wont to do.
Scoop up some beads — just don’t get any red ones! (Image credit: Michael Arthur Johnson Company)
Now, I hope you can imagine the futility of this situation: The operator, who has no control over the distribution of beads either in the bin or on the sifter (how many are red versus white), is having his or her work appraised on the end result of this tally. And the supervisor is either praising or demonizing the operator based on what is all just random probability. This is exactly what goes on in every company that isn’t “woke” to what Quality actually means. We put people in hopeless situations every day in every company, and they hope they can succeed against ridiculous probabilistic headwinds. And these headwinds have nothing to do with competence or working hard enough; they’re molded entirely by the systems out of which the results derive. Variation is a part of every system. The “system” is primarily responsible for employee performance. To improve your outputs (quality), you must improve your systems and processes.
You can’t “do” good Quality without a strategy and structured thinking. You need to understand why the principles of good quality are what they are, and deeply understand the nuance of what’s going on. Only then can you get to a level of higher quality. I use this metaphor with audiences quite a bit now: If you want to learn to paint like the master painters (e.g., Rembrandt, Monet, da Vinci, etc.), you need to study what it is they were doing, the mechanics of their approach and its nuance, and how they approached their art. To just “paint harder” would be naïve. And would fail. Like many Quality initiatives and approaches.
One of the things that underpins the principles of good Quality is that there are, in fact, principles of good Quality. Quality and compliance are NOT synonyms; you can be completely compliant with the regulations (FDA and/or ex-U.S.) and be nearly devoid of “good” quality. The FDA is attempting to improve this situation to some degree with newer initiatives on culture of quality, quality metrics, quality by design, and others. Next, please note that “doing everything” is not good Quality.
Here’s an example: Several years ago, I was hired by your (probably) favorite coffee company to review their practices that were most closely tied to customer satisfaction, continued re-orders, and repeated visits. To do this, you could plot a multitude of data for so many multivariate things. But the reality boiled down to three (3) key pieces of operational performance that would then beget virtually all else. To go further than that (with respect to multiple regressions of data) without an underlying hypothesis is simply misunderstanding the basics of science and the handling of data. I’ve discussed this in great detail in a previous article. Read it and learn tips to be a masterpiece painter with data. Not a fabricator of data junk.
About The Author:
Ben Locwin, PhD, MBA, MS, MBB, is a healthcare executive who has worked with regulatory authorities and organizations to bring the future of better Quality within reach. This work has transcended industries and has included work improving the quality of patient care in hospitals and emergent and clinical care centers, and improving quality in the aerospace, automotive, food and beverage, and energy sectors. Connect with him on LinkedIn and/or Twitter.