Sunday, March 13, 2016

The Quality Value Proposition

The Quality Value Proposition

I have been reading (always dangerous) recently in the Patient Safety arena about a concept  sometimes called the Quality Value Proposition.  It proposes that one can take the ethereal construct of  Quality and divide it by the tangible construct of Cost, and thereby determine the Value of Quality.  

(In mathematical terms it would be Q/C=V). 

The argument is that if the goal to be achieved is Quality of effective and high value, it is achieved first with the least cost, i.e.achieving more Quality per dollar or best bang for the buck.  Alternatively if costs are not reducible, then the Quality has to be of a higher grade to achieve a better value.


This scores higher than most in the contest for the most inane concept presented anywhere.  That it gets published and repeated talks more to the challenges of some of our great thinkers.  Shame on them.

So let’s take this apart.  

There are multiple views of what is Quality.  I refer you to the Quality classic Zen and the Art of Motorcycle Maintenance by Robert Persig.  If you didn’t read it when you were young in the 70’s you were either too young in the 70s or were just not cool.  

Quality as an intangible, a sense of being more perfect or more satisfying.  A Cadillac versus a Ford, A Harley Davidson versus everything else.  Or you can think of Quality in a Crosbian “meeting customer requirements”  or achieving customer satisfaction.  In any case it is still an intangible, and both a real and ethereal wisp.   You might want to quantify Quality by saying approaching or achieving error free, but it would be still difficult to put a number on it.  (Indeed accreditation bodies may pronounce an organization as having achieved 98% Quality.)  The point is that Quality is an achievable state, but is not a substance to be divided.

Cost I understand.  Cost of Quality – Cost of Poor Quality – Costs of Error reduction.  These are all real numbers and numbers in depth.  You can calculate them almost to the penny, provided that you can put a specific amount to stress and strain, two critical outcomes of error.  

I think that calculating true costs by looking in depth not only at the costs of prevention and appraisal, but also internal and external failures is a valuable exercise.  Something that everyone can do at some point and with certain projects to really appreciate how much money is lost on error. 

But most organizations don’t do that.  What they do is look at prevention costs and appraisal costs and then decide that they are spending too much on Quality Control and Quality Assessment and Continuing Education and then announce with regret that these are unaffordable costs that have to go.

Calculating Quality Value turns into a Lean Reductive strategy.  If I cut out 25 steps and use my reagents twice, then I have saved money and my costs go down, so now I am achieving the same "Quality" but with less expenditure.  This must make my Quality more efficient and therefore of higher value.   (Just in case you are reading this and this this makes sense, I will tell you  this is all about sarcasm.) 

What they don’t realize, because they probably choose to not look, is that when Quality Prevention and Appraisal activities and costs go down, Quality much sooner than soon will start to deteriorate.  More errors will inevitably occur.  

You have not made Quality better…. You have made Quality worse. 

So I understand how people all want to be like Einstein and create a simple formula that explains everything.  But this Quality Value Proposition is not it, and will never be it.  

As the cop on the beat says when there is a big splat in the middle of the road..   "Move on folks, Nothing to see here".  

This is a bad idea that has had more than its share of 15 minutes.   

Time to shut this sucker down.

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