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DATA SANITY: A Quantum Leap to Unprecedented Results

What they’re saying about Davis…

"We need this kind of education for our leaders in quality, including our Board and committee members who look at a change in results and draw many conclusions, not all appropriate, leading to a lot of demands for activity that gets confused with accomplishment.  Thank you very much for your perspective."

Chief Medical Officer
St. Johns Hospital
Springfield, Illinois

The Fuel of Quality

What’s it going to take?

Remember my previous article on the quality pyramid where the very top element emphasizes the concept of “process?” One of the most powerful points to get across in any quality improvement effort is that your current processes are perfectly designed to get the results they are already getting. Most of us are familiar with the fact that 85 percent of the problems in any organization are due to bad processes (and Deming, toward the end of his life, thought it was closer to 97%).

Don’t believe me? Here is the absolute best paragraph I have ever seen to explain it. This is from Jim Clemmer’s seminal book Firing on All Cylinders, published in 1992 (Business One Irwin) and still worth a read or listening to on CD:

“Only about 15 percent of [problems] can be traced to someone who didn’t care or wasn’t conscientious enough. But the last person to touch the process, pass the product, or deliver the service may have been burned out by ceaseless [problem solving]; overwhelmed with the volume of work or problems; turned off by a “snoopervising” manager; out of touch with who his or her team’s customers are and what they value; unrewarded and unrecognized for efforts to improve things; poorly trained; given shoddy material, tools, or information to work with; not given feedback on when and how products or services went wrong; measured (and rewarded or punished) by management for results conflicting with his or her immediate customer’s needs; unsure of how to resolve issues and jointly fix a process with other functions; trying to protect himself or herself or the team from searches for the guilty; unaware of where to go for help. All this lies within the system, processes, structure, or practices of the organization.”

What people don’t realize is that, not only does this apply to organizational results, but it also applies to two deeper cultural issues:

  • The “resulting” behaviors tolerated in managing people
  • The “resulting” behaviors tolerated between workers

Quite simply, culture is created by what is tolerated, which then drives an organization’s results. Can you see the frustrating emotions inherent in a culture when these causes and behaviors are allowed to thrive?

I got some feedback that my “quality pyramid” article, “The Engine and Fuel of Quality Improvement,” was short on specifics. So, I’m going to begin the process of remedying that; but it’s not as easy as “here are the 46 steps for changing them.” Some of you will not like my answers and what they imply for you.

First, laminate Clemmer’s quote and use it to eradicate “blame” in your culture—both in yourself and any meetings you attend. That has the potential to cause a quantum leap in morale and get you a lot of respect.

Second, if you aren’t satisfied with the results of your quality improvement efforts, ask yourself, “How do I have to change to get the organization to change?”

Peter Block, for whom I have a lot of respect, says that “The time is now for a conversational moratorium on statements and topics such as:

  • It’s important to have the support of top management.
  • Workers do not want to be empowered.
  • Leaders need to provide a good role model.
  • How do we hold people accountable?
  • How do we get people on board and aligned?
  • We need to be customer focused.
  • How do we do things faster and cheaper?
  • How do we give more choice to the people close to the customer?
  • We need a clear and common vision.
  • We need to have ground rules for dialogue, consensus, teamwork, decisions, and feedback.
  • It is important for us to understand systems thinking and whole system change.
  • We need servant leaders and the end of command and control.
  • We need to commit to continuous improvement.

“All of these points are true. It is just that they have become useless to talk about. They have become habitual language and we have become anesthetized to their meaning and depth. These words, because of their popularity, now belong to someone else, not to us. The phrases get used for persuasion and political advantage, not for their capacity for human connection. They have become the party line and evoke unconsciousness and keep us frozen in the comfort of routine,” adds Block.

So, if you are experiencing frustration from the same reasons that Block notes, you are perfectly designed to. These, in connection with Clemmer’s observations, now create a culture that is perfectly designed to exhibit the “victimits virus” (currently a plague at large in U.S. culture). Now what? What can you do?

A new definition of accountability

Given the tough economic times, the old-fashioned concept of “accountability” seems to be returning but in an outdated context of adherence to “tough” organizational goals through draconian enforcement and consequences. “Who’s to blame?” is sometimes euphemistically replaced by “Who’s accountable?”

With a deeper understanding of “process,” I still feel that zero tolerance for blame should be an organizational norm (the odds are at least 85 to 15 in your favor). However, that does not absolve people from being “accountable,” but rather, redefines it.

Accountability should no longer mean “account for.”

Yet, so much time is spent in meetings listening to litanies of excuse making, finger pointing, blaming others, confusion, an attitude of helplessness, or carefully crafted stories to explain lack of results. There must be a deeper transformation in mindset to a sense of reality, ownership, solutions to problems, and determined action. True accountability is powered by commitment and hard work with a focus on current and future efforts rather than reactive and historical explanations.

I have found that, if you wait long enough, someone exhibiting the “victimitis virus” will eventually ask a generalized question beginning with “Who,” “Why,” or “When.” There is a very simple technique developed by John Miller (www.qbq.com). Buy his book QBQ! The Question Behind the Question (Putnam, 2004). It takes less than an hour to read. I use it as prerequisite reading for any executive retreat.

When faced with a whiny “Who,” “Why,” or “When” question, ask the person to restate the question under the following conditions:

  • “Lack of… ” is never acceptable as a barrier; lack of “time” equals lack of “priority.” (These are only barriers because the current culture is “perfectly designed” to have them be barriers.)
  • Restate the issue via a question beginning with the word “What” or “How.”
  • It must include the word “I” (Note: Not “we”).
  • It must contain an Action.

I was once speaking to a group of more than 100 health care personnel in Cornwall, England, and was warned that a “grand old dame” of Cornish medicine would be coming. She had a tendency to disrupt things with angry rants.

During the question-and-answer period, she made her presence known, stood up, and began, “This is all very well and good, but what about Tony Blair and the ministers? Who is going to give this message to them, and why hasn’t anyone done so, and it’s futile to keep on going the way we’re going….”

I interrupted her, “Excuse me, Madam, I would like you to try and reframe what you just said using a question beginning with ‘What’ or ‘How;’ have it include the word ‘I’ and contain some type of action. Can you do that?” She was absolutely indignant! “Please work with me here and give it a try,” I continued.

She looked at the floor for about 30 seconds. “How could I see to it that a group of influential physicians got you invited to speak to some health ministers with this important message?” she asked.

“There now,” I replied. “Isn’t that better?” I could feel the tension in the room virtually dissipate.

Do you see the power of this technique? It commits the questioner to suggesting an action and allows you to make them subsequently accountable for it. If they don’t follow through, they have in essence lost the right to complain in the future.

Other frustrating situations this technique enables you to handle are the many times when people try to get you, as the manager, to take on their problems. This technique is a way of allowing you to make them accountable for solving things and defining your role properly when you have them ask this what/how-I-action question. When they are finished, you then ask, “‘What’ will it take from ‘me’ to ‘make that happen’ for you?”; “‘How’ can ‘I’ ‘help you’ in that effort?”; or “‘What’ barriers do you need ‘me’ to ‘remove’ to make it easier for you?” If they do indeed succeed, you have now sown seeds of belief in the culture that they are actually empowered.

So, in line with some of the mantras I have suggested in previous articles, here is another, “No whining will be allowed… to go gently unchallenged!”

The successful quality professional of the future must now be savvy in basic organizational psychology and transform to the role of organizational change agent. It starts with changing yourself and looking at your current role through a new lens with the following caveats:

  • I can visit “pity city”; I just can’t live there.
  • “Lack of… ” is never an option.
  • If I can’t change a situation, I probably have to change the way I think about it.
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