Fit for Process versus Fit for Purpose

Recently I have had the chance to work with a number of laboratories around the world that are relatively early on in their march to Quality Progress (by this I don’t mean subscribing to the ASQ magazine, but actually trying to making progress implementing Quality Management in their laboratories).  What I have seen is a lot of implementing new procedures which will be hopefully in time active and appropriate. But so far maybe not so much. 

What I see a lot of is laboratories deciding they want to get accredited tomorrow or they are told by their overseers that they have to implement a quality system NOW.  So they buy a book, or hire a consultant and they start by looking at the documents that they have to create: Organizational Chart, Quality Manual, Mission and Vision statements, Standard Operating Procedure forms, Document Control List, Corrective Action Form, Quality Indicator Forms, plus, plus.  

So the documents get created “by the book”, and get set up for use “by the book”.  I call this Fit-for-Process; documents that can be shown to an assessor so that they can get a checkmark in the appropriate box.  

What I also see with these documents is a ton of documentation that that looks pretty, but seems to exist solely for the purpose of being seen.  They are not designed so they can be used to actually make the quality process work better.  They become documents of busy work.  What they are NOT are documents Fit-for-Purpose.

They remind me of Billy Crystal’s character Fernando who would follow up his catch phrase in some generically hip pseudo-Spanish accent, “you look MARVELLOUS” followed by “It is better to look good than to feel good (and you know what I mean)”.  

The problem of course is that the documents get created in response to the question, “what do we need?” rather than “why do we need?”

What happens is inevitable; documents get created to record everything on every topic on every occasion.  And then fatigue sets in and they get filled in not with everything or on every occasion, but with less stuff and less often. And not far down the road, they just stop, and the complaints start; “this Quality stuff is a waste of time, and we are so busy and we don’t have the time to waste!”  

The problem was not that Quality takes too much time, it is that implementation was done in a hurry, to Fit-the-Process, to get that checkmark, to get that accreditation done and out of the way.  The purpose, if there was any, was solely about getting the certificate NOW.  

The reality is the Quality takes time, and grows with insight and with organizational culture.  And if it takes a year or so, then let that happen.  

Quality Management systems create a framework for planning and assessing risk and reducing the number of repeated errors.  When implemented Fit-for-Purpose, the process saves time rather than consumes time.  When implemented Fit-for-Purpose, the process reduces stress rather than driving the Qualitists crazy filling in the pretty documents with the excessive information.  When implemented Fit-for-Purpose, your next steps are refinements, not overhauls or do-overs.

So as you charge forward towards getting your stars or your certificate, let me ask you the obvious…”what’s your hurry?”

Upon reflection, when it comes to building your Quality system, Crosby was spot-on.  Do it Right the First Time (DIRFT).

Doing it Right or Doing it Wrong?

Doing it Right

Recently I was reading the recent (August 2013) edition of ASQ’s Quality Progress and came across an opinion article by Bob Kennedy who jumped into the fray between W. Edwards Deming and Philip Crosby and said that in his opinion that Crosby’s first essential, Do it Right the First Time (DIRFT) was wrong on every level.  The foundation of his argument was that Deming proscribed against slogans and therefore Crosby and DIRFT was wrong.

 I have to say that Crosby was NOT wrong, and that DIRFT was NOT wrong.  I am not sure that Deming’s concerns about sloganism was meant to include concepts like DIRFT, but if they were, then in all due respect, in this circumstance, I would have to side with Crosby.  Even a pioneering genius like Deming could not always be correct all the time. 

When is comes to concepts like DIRFT, Crosby was spot on, and Deming should have acknowledged it.

First off, let me put some context around my opinion.  I understand Deming’s point of view.  There are some slogans that I think are unhelpful.  “There is no such thing as an Accident” .  “Accidents poison to our organization”.  “Time is money – time loss kills growth and progress”.  These are not slogans, they are less than idle threats that lead people to hide slips and simple mistakes.  There is little place for threats in the workplace.

But DIRFT is not a threat, and indeed makes sense.  Given the alternative I would hope that a neurosurgeon makes triplely sure he does it right the first time.  And by the same token, the same goes for the airplane pilot.  Even the woodworker says, “Measure twice and cut once”. 

DIRFT is in fact a reiteration of a concept that Deming was so proud to adopt, even if he did not state it, “PLAN DO CHECK ACT”.  (For the origins of PDCA see Deming did not create PDCA.  [ http://www.medicallaboratoryquality.com/2012/06/deming-did-not-create-pdca.html ] .

What DIRFT was intended to mean was before you do something, make sure that you have organized your thoughts before you put a plan into action.  It is the essential corollary to PDCA.  Think before you do. 

In the medical laboratory we have tons of examples where things don’t work that way.  Tests get implemented without proper validation.  Tests are done and reported before checking the Quality Control results.  Reports are sent to the wrong person before confirming who was truly was the intended receiver.  These happen all the time and in every instance they result in external failures with potential false reports, misleading information, loss of confidentiality and huge cost of poor quality.  And most of them were pointless and preventable. 

A few seconds or at most minutes of thought and planning could prevent most of these problems, and save the laboratory from embarrassment or potential liability, and save the patients from inconvenience or harm.

Perhaps in Deming’s time, folks were very aware and sensitive to threats in the form of slogans.  Labor protections, either under the umbrella union protection or workplace legislation either did not exist, or were in their infancy.

That is not the world in which we live today.  Today we live with 40 character headlines and 140 character tweets, and thirty second commercials.  We live in a slogan society, and we by-and-large put them into a more current context.  We may see slogans as jargon and trite or sophomoric, but we don’t see them as threats.

Personally I see DIRFT as rather aspirational.  I fatigue of avoidable errors, or repeated mistakes.  I embrace the notion that doing things RIGHT is better than doing things WRONG, and believe that many errors result from automaton-like behaviour.  I absolutely support “Plan before you do; Prevent the avoidable error”  and even more importantly, “Learn from mistakes; support continual improvement”.

So to Bob Kennedy I think with respect it is OK to relax on the absolute adherence to Deming’s word.  It is time to embrace context and circumstance, and to acknowledge that it is also possible to acknowledge that both Deming and Crosby were giant contributors to our current concepts of Quality.