Monday, November 8, 2010

Quality and the Zarbo Manifesto

There are many articles  that get published in the medical literature every month.  Some of them actually get read.  But every once in a while one finds a “must read”.  In the September 2010 edition of the American Journal of Clinical Pathology (AJCP) the editorial by Richard Zarbo (A Call to Change in the Status Quo in Approaching Health Care Quality, Once Again -- - Am J Clin Pathol 2010: 134/  361-365) is one such must read.  
 It is as clear a statement, a manifesto, in the purest form of the term “A public declaration of principles, policies, or intentions, especially of a political nature"..

Richard Zarbo is an anatomic pathologist at the Henry Ford Health System in Detroit.  He has been an ardent supporter of LEAN and the Toyota System for many years, and has documentation of some success in his institution.   
Importantly Zarbo recognizes that LEAN is not just about time and motion studies and spaghetti diagrams.  It is an integrated program of lessons learned by Taiichi Ohno in part from Ford, in part from Piggly Wiggly supermarket, all superimposed on quality as iterated by W. Edwards Deming and Walter Shewhart (Plan-Do-Check-Act).  It is a system of many integrated parts that can come together and create success.  

As pointed out in the editorial, all the Quality systems, however named (LEAN, or TQM, Continuous Process Improvement, or ISO9000, or ISO15189 or ISO17025) focus on reducing variation through standardization of process, and connections, and work activities, and through the monitoring of, and action upon objectively measured information both about successes and challenges (nonconformance or error).

But none of the approaches to quality have a corner on success; indeed most tend to the opposite.  Regardless of which approach is adopted, there will be some successful applications and many failures, because, in large part, of the variability of application, and lack of sustainability.   

The problem is that adoption is done by word only and not by action.

And that brings us to what I am referring to the Zarbo Manifesto for Quality Success. 
For purposes of this blog, I have paraphrased this Call to Quality as:

1: There must exist one Culture of Quality that will drive clarity, cohesiveness.  Absence of a binding culture is a leadership failure.
2:  Leaders and managers must adopt the principles of process improvement.  The spirit of participation will spread horizontally, but top management must drive adoption from the top.
3: Leaders must adopt the role to continuously work on improving the system of work to drive the new culture.  
4:  Structure must be established to teach and adopt PDCA and standardization throughout the organization.
5:  Structure must be established to teach and adopt continuous process improvement.
6:  Organizations must adopt structures to sustain success and recognize the importance  value of engaged workers.

Anything less is a licence for failure.

So the message is clear.  Leaders have an obligation to lead.

Count me as an advocate.

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