Quality and Excellence

Still enjoying summer but with a lot of projects and proposals on the go.  Hopefully they will all be ready by September.  Will talk more about them later. 

But today I received another email from the American Society of Quality (ASQ) with concern that the US government has put the congressional financial support of the Baldrige Performance Excellence Program on the chopping block.  The ASQ is asking its members (presumably just the American members) to write letters of support demanding the cuts can be prevented.

I understand that every organization needs financial resources to exist, and that the Baldrige Program is a P3 program (Public Private Partnership) which implies public support, but I certainly hope that along with this rally-the-troops email solicitation program, there is also a Plan B abrewing. 

In my opinion smart, forward-looking organizations make the decision that their operation will be enhanced by a Quality program and implementation is based on internal decisions.  Being seen as a best-in-class organization creates huge goodwill and creates a significant competitive advantage.  Given the choice between mandated quality and internal (volunteer) quality, the latter has a much greater chance of impact.  There clearly is a role for regulated Quality through mandated accreditation but Quality-by-force is a constant battle.   

When an organization sees benefit in Quality and implements because it wants to, the level of enthusiasm is higher and the level of activity is greater.  That is why I strongly see advantage in the US Baldrige or the Canadian National Quality Award programs.  Whether the program is funded or not, I suspect there always will be US organizations that will be prepared to implement some version of improved Quality and Excellence on a volunteer basis. 

But there are a number of key issues of which folks should be aware.  The Malcolm Baldrige program has been in place near 25 years as a public-private partnership.  The major private partner is the Malcolm Baldrige Foundation (MBF).  After 25 years if a foundation can not survive without government handouts then I would argue either the foundation is inept or the idea is not one worth supporting.  Second, the amount of money that is going to be withdrawn after 25 years is about nine million dollars ($9M), which again I would argue for a foundation the size and maturity of the MBF should be small potatoes, especially with all its very high 
 profile and the additional support it gets from professional organizations, including the ASQ.  

These days, if they still really need the $9M, there are tons of ways to raise that kind of money.  Remember that the Baldrige Foundation is supposed to be about organizational performance excellence through innovation and improvement. 

They could have a lottery for a Malcolm Mercedes or a Baldrige Buick.  They could have bake sales for Baldrige Bagels.  ASQ and all the other organizations could a 5% fee on memberships and book sales (Buy a book for Baldrige).  How about Malcolm mugs or Baldrige buttons? 

For a country with a 15 million-million dollar debt ($15T), another $9M represents the pocket lint found on the penny in the jacket pocket, but cutbacks are an inevitable political reality. Instead of having 600 assessment staff, could they get along with 540?   A drop of 10 percent could easily have a cost reduction worth millions.  A little LEAN thinking may be in order for the MBF.

So from my perspective, it is time to stop whining and time to start showing some of that innovation and improvement that the organization so strongly endorses and supports.  Put me down for two Malcolm mugs.

9004 - once more with passion

In 2009, Boiral and Amara published in Quality Management Journal (QMJ VOL. 16, 2009, ASQ: 36-60) that only about 25 percent of adoptions of ISO 9001 were effective, with the ineffective ones marred by internal or external barriers, or by little evidence of ongoing activity.  Those situations where there was little activity but few barriers to explain the failure were referred to as Managerial adoptions (the manager may care but no one else does).  Those with lots of activity but huge road blocks and pitfalls were referred to as Ceremonial (we adopted it, but we have no intention of allowing this to actually work).   Those where there was poor activity and huge barriers were called Ineffective (why did you even bother?), and the remainder showed ongoing success (Effective…Hooray!). 

I raise this because I suspect a similar pattern with ISO 9004:2009  Managing for the sustained success of an organization – A quality management approach.  There will be those (some) who become aware of ISO 9004:2009, and progress towards sustained success, but the majority will be unsuccessful.

ISO 9004 provides a useful approach to take the requirements of ISO 9001, but help enhance the view of shifting from just implementing because you have to in order to maintain your certification, to seeing value and purpose.  It promotes the use of factual evidence, awareness of changing environment, valuing employees, and monitoring customer satisfaction as tools to keep the organization moving forward towards success.  Success is enhanced not by creating a strategic plan and policies, but by communicating the strategic plan and policies, and setting forth to action and implement.  And succeed through success, meaning learning from your experiences and adopting  innovation for progress through positive change. 

One can see the influences behind 9004.  Focus on measurement (Six Sigma); focus on involvement and motivation of staff (Toyota) and focus on analysis and review (PDSA).  It completes the loop back to the beginnings of quality management.

9004 should be a roadmap to success. 

So why do I think that adoption and success will be small, especially in medical laboratories?  First and foremost, at least in Canada – and indeed probably most or all public sector funded organizations - there are no longer any traditional measures of success, because there is no incentive for success.  Medical laboratories will always “succeed” in the sense that patients will always come for care, and physicians will always send samples.  And the budget will always be there.  Closures don’t result from doing bad things, or bankruptcy; they come from higher level “efficiencies”.  And in a union shop environment, the concepts of personal pay-for-performance or bonus-for-excellence have been wiped off the table.  Laboratorians in institutional laboratories no longer know what success looks like.

The only real measure for effective success is, in my opinion, professional pride, and the sense that MY laboratory is the best, a concept much more of the ‘60s and ‘70s than of today.  Today the notion of organizational pride and the spark of competitive edge are all but completely wiped out.  That is not to say there are not still organizations committed to National Quality Awards and the Baldrige Award, but they are truly few and far between.

So does that mean that Qualitologists should write this document off as “interesting but not realistic”?  I don’t think so.   Read it, and think about it.  There are some pearls here.  Some of them may even be enough to help overcome some of the afore-mentioned barriers which could contribute to some of the ceremonial adoptions may shift over to being more effective.  Some of the practices may improve to the point where more than just the manager cares. 

Long term hopes and aspirations? Absolutely.  That is what we call strategic planning for long term success.

PS:       I am aware that few medical laboratories focus on 9001 as their source document for quality.  9004 is fully compatible with ISO 15189, and as far as I can tell, with CLIA.

Next time.  The two major holes in ISO 9004:2009.  

The Power of Voluntary Quality

If there is a single discussion point around which I am totally in self-conflict, it is the arena of voluntary efforts for quality versus mandated efforts.  As a libertarian by personal inclination, I am resistant to government mandated initiatives for Quality.  I see the consequences of mandated Quality all the time.  Mandated Quality becomes resented Quality.  
If we are not seen to do something, then someone can impose themselves.  It may mean imposed accreditation or imposed proficiency testing where the point of both exercises is not about improvement and all about getting it done an passed so that “they” will leave us alone until the next time.  Given a choice between using either or both as a learning exercise, or a something that just has to be complete with a good mark, it is strongly advised to “game for success” rather than risk intervention.  
On the other hand, as a Canadian, I see what happens in the absence of mandated Quality.  It is not by accident that our most public of Quality embarrassments (see the Cameron Commission) occurred in a part of the country that has never believed in required Quality in healthcare.     In Canada the experience unfortunately is that if you don’t mandate it, it does not get done.

That is a pretty gross overstatement, of course, but it gives me the opportunity to turn this towards an even bigger problem, not seen in Canada (more on this later) but in the US; the single greatest onslaught against voluntary Quality in the last 25 years.  As part of the new fiscal responsibility, the US white house and congress is starting a dismantling of the Baldridge Performance Excellence Program.  

The Baldridge program, first developed in 1987 under the Reagan administration created this program, with a mission to “enhance the competitiveness of U.S. businesses” It has served as a voluntary program with an national award for improvement and excellence and leadership for role models and best practices. In 1999 it was expanded to cover healthcare and education organizations, and more recently in 2005 to cover nonprofit and government organizations.  Even if it is not available in countries other than the US, it is a program that we should all hold in the highest regard because it recognizes and rewards those of us interested in Quality and Excellence, not because we have to, but because we want to.  
So why am I writing about this.  Today I read that this program which has a total budget of about 10 million dollars is slated for an over  20 percent reduction (2.2 million).
Now I strongly support tighter controls on federal governments everywhere.  One only has to look at what is happening in Greece, Ireland, Spain and Portugal to see what can go wrong.  And watching the US promote stimulus through setting the world back on the road to massive  inflation is frightening.  
What I find short sighted here (in addition to the obvious) is that organizations interested in Baldridge are not only the leaders in Quality and Excellence, but they are probably the leaders in Costs of Poor Quality containment.   If the reduction in funding results in fewer applicants, and this results in lower CPQ savings, this will be the worst $2M congress has ever saved.
What needs to happen is that the Baldridge becomes a public-private partnership with private funding but with an award that continues to carry the power and influence of national recognition.  
Message to the folks, never trust Quality to the hands of politicians.  

As a Canadian I have to wonder why no federal or provincial government has ever thought it reasonable to initiate a Canadian award for Quality and Excelllence.  Since we are in the middle of an election, maybe this is a good time to find out.

PART B
I was just at a meeting held by the International Laboratory Accreditation Cooperation (ILAC) because they have a committee with interests in proficiency testing and laboratory quality services for developing countries.  Not much to write about from the meeting, but I can show you a picture of a famous statue in the town.  
Question: Name the statue and name the town.

PART C
The attendance for our POLQM Quality Weekend Workshop is rolling in.  The early bird registration ends May 1.  If the meeting is of interest, it is time to register now and save $125.
Visit: www.POLQMWeekendWorkshop.ca