Making the Healthcare Mission Real

Making the Mission Real

In a previous post [see:  http://www.medicallaboratoryquality.com/2016/03/cum-minus-facerent-malum.html ] I railed against the tragic levels of customer service in  Canadian Healthcare.  In as much as being a disgruntled healthcare customer (nobody really wants to be in a position of needing healthcare services) as a Quality person I was appalled at how far off track we have come.  

 If there was a single irritant above all the irritants experienced it was the declarative Mission Statement (however named) “Embed patient-centered practices in the delivery of all care and services.”  This might have been written in some aspirational moment of hope, but in reality it was both meaningless and, at least from the perspective of this one observer, galling.  In my experience there was no evidence of any effort to support or justify such a declarative statement.

 

What it made me appreciate all the more is the concept that Mission Statements have to be more than a bunch of nice words, they have to be credible and achievable in a way that the customer and employees can point to an say “Yes, and good-on-ya”  

So it made me think of all those statements that sound good but are of little use.  They remind me of the Crystalian character Fernando, “It is better to look good than to feel good”.  All SHOW and no GO. 

Here are a few:

Quality is Job 1

We meet and beat all requirements and standards of excellence

We provide world-class service.

We are the world leaders in care.

Excellence in all actions all the time.

(and with apologies to Philip Crosby) “Doing it Right the First Time Every Time”

Mission statements are important.  As pointed out in ISO 9000, the organization's mission statement or policy is its “purpose for existing as expressed by top management”.  If it is not real, staff and customers have nothing to hold on to and either ignore or scoff, or as in this situation get angry.  It doesn’t make the organization better; it makes the organization worse because it provides the opportunity for cynicism.  Good words-No substance.

So here is how I see it. 

There are some organizations that need the Fernando Format.  It is not about Quality; it is about profile and promotion; high profile major manufacturers may need at least as much pizazz as punch.  That is about advertising and promotion.   But healthcare organizations do not fall in that category.  Healthcare needs to “put up.  Period.”  Healthcare needs to be good, not just look good. 

So can we agree that unachievable mission statements achieve little other than make the promotion folks feel good.  So put out the message that we want to be there and intend to work damn hard to get there.  And on that point you can hold us accountable.

Our vision is to be recognized by our community and peers in Canada and beyond as a valued contributor to healthcare delivery and  innovation and as a passionate advocate for continued quality improvement for the benefit of patients and their families. 

Too long?  Maybe, but it  delivers  real measurable aspiration. 

I am open to suggestions for improvement.

Slogans, Exhortations, and Targets

Slogans, Exhortations, and Targets

It is relevant to remember that W. Edwards Deming passed away nearly 20 years ago, and that while brilliant and a visionary in Quality, he was not the only person to develop a Quality philosophy.  That being said it is really important to take note of the Deming method and to consider it as a key measure of context. 

For those that are not studiers of the Deming Management Method, I will tell you that it was largely built around a series of 14 points and 7 deadly diseases.  If you are not aware, or were aware but have forgotten, I will tell you that there continues to be a lot of wisdom here that is worth reading and considering as you implement Quality program of your own.  There are a bunch of places to find this stuff, on the web and in books.  One oldie, but goodie, that we still use in our course is “The Deming Management Method by Mary Walton.  It was written in 1986, when Deming was 86, and he wrote the forward for the book himself. 

One of his 14 points was “Eliminate slogans, exhortations, and targets for the workforce”.  His point was that slogans don’t make things easier for the worker, they make things harder.  They make for unreasonable expectations, and create more anxiety and frustration than they provide encouragement.   One slogan in particular that he hated was “DIRFT – Do it right the first time”.  There are a number of writings that make it pretty clear that Deming and Crosby did not see eye-to-eye in a number of areas.  I suspect that at a very gut level, Deming was not a fan of Phillip Crosby.

But before I go off too far on a tangent, I will say that what Deming was a fan of was making things measurable.  Continual improvement is not a state of mind, it is or is not a measurable mathematical reality.  Define the conditions for improvement and develop an indicator that you can count or otherwise objectively measure.  You either meet the measure or you don’t.

I mention this because I was flying back from a meeting, flipping through the airplane magazine and I saw an advertisement for a car.  There was a big and bold punch line:  “Excellence wasn’t our goal.  It was our starting point”.  As I read the line, my first reaction was “well I am sure some ad exec thought that was pretty cool, but from a Quality perspective it’s pretty dumb”.  And then, knowing that Deming had worked within the automobile industry, I wonder what Deming would have said.  Well I know what he would have said. 

Deming in the early 1980’s was a consultant for the Ford Motor Company and was instrumental in helping them make the transition from the flash and excess and poor construction of the American automobile that characterized the fins and weight and gas guzzling of the fifties and sixties and seventies.  He taught them that in the long run meeting positive expectations year over year was the road to success.  Rather than making flash as job 1, or making speed as job 1, Ford would succeed making Quality as Job 1.  And thus a very successful, and measureable slogan was born.  

And in 2008 when Chrysler and General Motors were dying, Ford was able to say “no thanks” to the bale out. 

I continue to see sloganeering in advertisements but more in Quality mission statements.  I argue that meaningless phrases that are impossible to measure or impossible to address have no role in Quality mission statements.

We provide “world-class” service.

We are the leading edge service provider.

We are the bleeding-edge of our industry.

We are the best-in-class world stage performer.

We meet or exceed all world class standards.  (Even if this sounds measurable, what does “exceeding” standards mean?)

I guess it all sounds sexy and flash, but it is just nonsense. 

Deming would not have been impressed.