Thursday, May 31, 2018
The Culture Quality Interface
The Culture Quality interface
Culture and Quality has been a long-time interest of mine. I have stated with total certainty that an organization needs to have a palpable Culture of Quality in order to succeed in Quality Improvement.
I still believe that to be an absolute truth, although I have moved a little bit from the absoluteness of the statement. Today I am more comfortable with the saying that having a Culture that supports Quality may or may not lead to significant improvements in Quality Improvement, but if the acceptance and interest in Quality is NOT there (i.e. if there is no Culture of Quality) there is absolutely no chance to creating any lasting Quality Improvements.
Said another way, even if everyone sees the value and importance of Quality, improvements may not last because financial, or changing dynamics, or other interferences get in the way. But with absolute certainty, if no one in the organization gives a damn, the likelihood of improvement is not only zero, the greatest expectation will be that more errors will occur, staff will be more indifferent and whatever level of Quality there is, will get worse. It is stunning how often we see that in action.
So understanding Culture is essential and integral to implementing Quality Improvement.
With that in mind, the last few days have been really enlightening for me because I was able to change out of my teaching and investigation mode and became a student by taking a course in culture improvement. The centerpiece of the course was exploring the Organizational Culture Assessment Instrument (OCAI) which can be used to define and characterize the competing values of culture types.
The course was given by Marcella Bremer who lives in The Netherlands and is a major player in the international community of Culture improvement.
The course was just what I needed; away from the office and intrusions for 3 days and the opportunity to focus. Most participants were consultants from across 5 continents wanting to explore and dabble in OCAI. I also met a kindred spirit; a person working in another university setting and struggling with all the same issues that I also have to deal with, and maybe worse.
Without going into too much detail, the developers of OCAI were deeply interested in the nature and personality of organizations (all organizations) and studied many cultural characteristics. Through comparative analysis, they were able to weed down to 4 major personality influencers and types:
the processes that bring order and CONTROL to an organization such as standards and guidelines, top down management, process and procedure, quality control, accreditation etc.
The processes that bring collective COOPERATION to an organization such as staff engagement, kaizen, etc.
The processes that bring CREATION to an organization such as research and development, new programs, new methods, new strategies, etc.
The processes that lead to COMPETITION such as methods that increase market share such as market strategy, market growth, customer satisfaction. (note: in healthcare, there are elements of competition that exist such as wanting to find more patients, or more studies or more grants, but mostly what we are try to focus on is more and better satisfaction).
What is, or should be intuitively obvious, is that each of these elements is essential and the choice is not one of exclusion, but of balance. Sometimes an organization’s improvement needs a little more top-down support. Other times the opposite may be what needs to happen.
We spent little time talking abut the OCAI itself (it is after all only one management tool), and much more on what organizations can do if they believe there is room for culture adjustment and how the information within OCAI results can give some guidance. What is pretty clear, is that (a) it is not as easy as snapping your fingers and (b) it can be a lot more straight forward and not as hopeless that you fear it might be. I left with some definite ideas how I could make things happen.
For me, this time away from the office was a total success; what could be better than getting to spend 3 days with people pretty much of like mind exploring new thoughts and new ideas.
But as I said at the beginning, strengthening a laboratory’s collective culture and interest in Quality Improvement does not guarantee there will be success. But doing nothing will assure that improvement efforts will not lead to success, and more importantly, will either remain static, or slide down the pipe to more error and failure.
What a choice!!