Quality Management vs. Total Quality Excellence

This past week it is doubtful that any of us didn’t pause for a few minutes to reminisce about Robin Williams’ acting career.  From the voice of the genie in Disney’s Aladdin to Good Morning Vietnam and many others, he will be remembered and missed.  For many, Robin Williams’ best role was portraying John Keating in Dead Poets Society.  Some readers may be scratching their heads and wondering where this article is headed but please indulge a fan.

The movie Dead Poets Society is set in 1959, and to the students, parents and faculty at the very traditional Welton Academy with the motto “Tradition, Honor, Discipline and Excellence” John Keating’s teaching methods are unorthodox.

They include taking the students out of the classroom to focus on the idea of carpe diem (seize the day), and telling them, if they feel daring, they may call him “O Captain! My Captain!” a reference to a Walt Whitman poem based on Abraham Lincoln’s assassination.  At the time it was published, Whitman’s evocation of triumph overshadowed by despair spoke to readers throughout the shattered nation.  It likewise spoke to Keating’s students.

In other classes, Keating instructs his pupils to rip the introduction out of their poetry book as it presents a mathematical formula to rate the quality of pieces of poetry.

In another scene while straddling two desks, Keating encourages students to stand on their desk in order to look at the world in a different way.  The students hunger for freedom and knowledge and willingly trust and embrace Keating’s unconventional leadership style.  Without a doubt, Keating taught them to think out-of-the box.

Welton Academy, with its rich heritage and refined motto, may represent any number of healthcare organizations driven by rules, norms and policies.  By no means am I inferring that a code of tradition, honor, discipline and excellence, is a bad thing in either our educational or corporate systems.  Nor am I suggesting that the Key Performance Indicators, and metrics commonly captured by healthcare organizations should be torn from your organization’s annual reports.  worldhealthlife

Yet, the ridiculous notation that the quality of a piece of poetry can be derived from a mathematical formula seems to parallel the overabundance of performance indicators and the lust for mega data to judge whether a hospital or physician is doing a quality job.  Healthcare, like poetry, cannot be reduced to a mathematical formula.

Quality management began in manufacturing with a focus on processes.  From the Ford assembly lines to Six Sigma, quality engineers set the rules, norms, and controls in place and expect the machines to operate with minimal or zero defects.

Control and conformance to operating requirements, like the model of learning in place at the Welton Academy, is designed to reduce variances and improve the “quality of processes.”  Quality management is a viable tool for any organization to measure specific areas of work, but it alone does not guarantee the organization will achieve total quality excellence.

The Institute of Medicine (IOM) defines healthcare quality as “the extent to which health services provided to individuals and patient populations improve desired health outcomes.  The care should be based on the strongest clinical evidence and provided in a technically and culturally competent manner with good communication and shared decision making.

Total quality is best defined as an attitude, an orientation that permeates an entire organization, and the way in which that organization performs its internal and external business.  People who work in organizations dedicated to the concept of total quality constantly strive for excellence and continuous quality improvement in all that they do.”1

The mathematical performance indicators (formulas) currently in place are a tool to help a healthcare organization achieve excellence.  The metrics are a component of total quality not the end for all.  More importantly, the IOM definition explains how an organization goes about achieving that level of excellence.  Achieving quality requires people to interact and trust.  Research has shown trust and collaboration are key components in producing a high-performance culture.2

InDead Poets Society, Keating developed an open and direct style with the students.  His willingness to speak the truth rather than pass on organization-speak propelled the students to a rapid awareness of trust and an understanding of what quality means.

Frankness and honestly can do wonders for an organization, but many people, even those on teams appointed by or even with senior management representation, fear being candid due to the risk of being misunderstood or possible loss of power or acceptance.  The easy out is for the organization’s leaders to focus their energy solely on the metrics.

Yet, to achieve the desired outcome of total quality what is most important from the leadership is encouraging a culture of open, direct communication that will build trust in any organization.

In order for people to embrace the drive for total quality excellence they need to trust the organization’s willingness to examine, to question, to invest, to risk, to think out-of-the-box.  They know it is acceptable to stand on their desk to see a process in a different way because their leadership openly communicates and demonstrates behaviors that promote a culture of trust that permeates the entire organization.  Only then will the goal of total quality excellence be within their reach.

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