Quality and Leadership: one step too far

Bill Troy has written an excellent entry on the links between Quality and Leadership, which many (I for one) see clearly.  In my Certificate course I get to meet many who have decided to transition their career to one engaged in Quality Management, because they see that as a good entry to a leadership role within their profession. 

I just think that Bill has moved the dial a little bit more than is comfortable for some in the ASQ family.  

But before I get to that, let me say that Leadership may be aspirational, and may be transformative or transactional or indeed all three.  If only we could figure out what the heck it is.  There are so many active definitions at play from “A leader is someone who has followers”, to “leadership is the capacity to translate vision into reality,” to “leaders will be those who empower others” or “leadership is influence – nothing more, nothing less” and even “leadership is a process of social influence, which maximizes the efforts of others, towards the achievement of a goal”.  

After years of reading and thinking I personally have decided that the Potter Stewart approach is probably the most practical.    

In 1964 while sitting on the bench of the US Supreme Court, Potter Stewart was commenting on a case about a certain movie and whether or not was appropriate for viewing.  The issue was should it be protected as free-speech and should it be excluded as hard-core pornography. Stewart said (paraphrased)…  “I shall not today attempt to define [pornography], and perhaps I never intelligibly can, but I know it when I see it.”   

That’s how I feel about Leadership.

Note:  For those whose jaws have just dropped thinking that I have maligned leaders and their leadership talents, I am not linking leadership with pornography, beyond to notion that the two concepts are both easy to recognize, but near impossible to define.

But to get back to Bill’s comment, he wrote: “we want, need, and expect every one of our members—and indeed, every person in the quality community—to grow and develop as leaders.  

And in that I have a problem.  

The other day I was in a conversation at a healthcare academia curriculum workshop about leadership.  One notion put forward is that as part of the professional curriculum we should always be including instruction on leadership because we all have a natural drive that aspires us to leadership, and a duty to lead, but we don’t know how.  It sounded so powerful and so fulfilling; how could you argue against.  

But I did.  I think it is nonsense.

 In my experience in laboratory management, I see two groups of workers, both excellent at what they do.  When given the opportunity to take on a special project, some jump at it. They love the opportunity, they love the recognition, and they love the opportunity to get ahead.  Given the distribution of age, and gender, and ethnicity it would be nice to say you can pinpoint this group because they are all young, or all women, but it doesn’t work out that way.  

But there are others who are quite happy to do their work diligently and accurately and (near) error free, and leave room for others.  It is not a matter of shyness or self-deprecation.  It is that they are very satisfied with what they are doing and are quite happy to continue grow within that framework, but they are not driven to new frontiers. They are happy to work hard and hone their talents and skills, but at the end of the day they prefer to go home to their family and friends.  Their lives are both fulfilling and complete and they do not feel the need to be team leaders.    

Both groups are equally excellent workers and both are essential as part of the staff.  One group clamours for new adventure, the other not.  Denying the one group leaves them frustrated.  Pushing the others can jeopardize their excellent work habits by adding in unwarranted distraction. 

The challenge to leadership is to figure out which group is which and how to make all of them happy to be on board and working with you.

So to Bill I say, “want and need…”, absolutely.  “Expect…” let’s not go there.

Promoting Success (R)

Promoting Success

In my previous entry I wrote on our successful re-certification now running for 11 consecutive years.  We received a positive comment congratulating us on our success.  It was much appreciated.  But of interest, I received some emails that were more negative, the gist of which was that there is little point for self-promotion other than satisfying some personal need. 

With respect I have to strongly disagree. 

Reporting and promoting success is a critical part of the culture of quality.  Here are some of the reasons why:

• Meeting certification or accreditation requirements does not come easily; it takes a lot of work and a lot of commitment from all your staff.  Letting people know of your success is one way of rewarding through recognition for their efforts. 
• Promoting success is an important building block for group culture of quality.  Making others aware of your achievement reinforces the positives of working within your organization.
• Quality Partners have an obligation to be seen to both “talk the talk” and also to “walk the walk”.  It is our demonstration to our partners and customers that we take Quality seriously.  If we can do it, then so can others.
• Our customers, in this sense the hospitals and laboratories and physicians that work with us, need to be aware that laboratories do have standards and participate in inspection on a regular basis, and that when we are assessed we are found to be meeting our requirements and achieving success.  This is especially important for Quality Partners like Proficiency Testing providers and Accreditation Bodies.  All too often laboratories believe that we work to our own interests and set ourselves up as experts and authorities.  I learned this the hard way when I was publically scolded by a laboratory technologist for this very issue.  Indeed, it was this experience that made me realize that animosity for accreditors and proficiency testing suppliers and regulators runs very deep; we are seen with a lot of suspicion.  It is very important for laboratorians to know that just as we have expectations on them for success, others view us in the exact same way.  And more importantly we commit to the responsibility for those expectations. 
• The people who make decisions about whether or not they should use our program need to be aware that we go the extra mile to ensure that we can provide value and that we are open and transparent when it comes to our own Quality.  They have confidence that they made the right decision to work with us as a Quality Provider. 
• The public needs to know, especially in the environment in which we live today that we take Quality seriously.  Again this week failures in laboratory performance (radiologists in Quebec) were front and centre in the news.  The public is regularly become aware of our failures.  It is important for them to be aware of our successes.

I am surprised at how many organizations don’t recognize the importance of sharing with others their success.  Most private companies get it, and it is common to see logos and certificates on their advertisements, their trucks, there letterhead and their web-sites.  Promoting excellence has a business value.  I recognize that in North America the majority of laboratories are public sector rather than private and business is less a consideration. 

But confidence building and quality assurance have cachet.  Everyone from politicians, to regulators, to administrators understands the public value of confidence and quality assurance.  That is why there are institutions like the National Quality Institute and the Malcolm Baldrige National Quality Award.

So we intend to continue along our path to inform all our customers of our success through our newsletter, our website, and send-out materials.  We will raise awareness at every public speaking opportunity.  And we will continue to do this year after year.  And for those who consider promoting success as some sort of self-aggrandizement, or bragging, or manifestation of superiority, or some casting doubt on the quality and competence of our colleagues, they need to deal with it. 

Leadership and Quality – Part 2

I mentioned previously that I have been going through The Harvard Business Review must read book, The Essentials.  I am intrigued by the theme of Leadership and its parallels to Quality.  The article in The Essentials, first written by Daniel Goleman in 1996 was a seminal paper on the topic.  Its publication in 2011 continues to show its influence in the leadership arena, even though Goleman past away in 2010.

Anyone who works in an organization knows and understands that some folks are better leaders than others.  While it has something to do with skill and talent and knowledge and problem solving, it is also their ability to interact with people.  In the 1920’s (at the same time as Shewhart was setting the foundations of Quality) Thorndike was introducing the concept of social intelligence.  In the 1940’s (at the same time as Deming and Juran and Crosby were defining Quality) Wechsler was defining the impacts of social-emotional intelligence on intellectual behaviour.  In the 1980’s and 1990’s (while Galvin was creating Quality measurement tools – Six Sigma) Goleman and others were creating tools to measure Emotional Intelligence (EI), and reporting strong correlations between EI and performance.

As Goleman saw the world, when he studied leaders in near 200 organizations around the world, what he observed was that intellect was a given key driver, as were the ability to think long term and to see the big picture, but the single biggest factor that distinguished high performance leaders from the rest of the pack was their ability to be self motivated and their ability to motivate others, as components of EI.

He defined five components to EI including the abilities to be self aware (self assessment and self confidence), the ability to self-regulate (trust and ability to deal with stress and change), motivation (in this sense, self-motivation and work passion), being empathetic (considering others) and having the social skills to move people.  Importantly will the right psychology tools all these were measurable and interpretable.  Even more importantly all these skills were both teachable and learnable.  

In Goleman’s world, leaders were not necessarily born, they actually could be created.  And seen another way, with sufficient motivation, a person could learn the talents necessary to become a better leader.  

Gradually as we went through the last 10-15 years, some (maybe much) of what studies about EI had eroded.  Not all the original research on the impact of EI and leadership has been reproducible; this as been especially true with respect to the studies between EI and performance.  Similar to Six Sigma, some of the so-called bloom has come off the rose.  Extending the parallels with Quality, see Noble MA.  2007 Does external evaluation of laboratories improve patient safety?  Clin Chem Lab Med. 2007;45(6):753-5.

There are a lot of parallels between Leadership and Quality.  Both of them are associated with helping organizations get the most and best performance from people.  Both of them focus attention on the seeing the primary task at hand and seeing the best way to achieve it.  While I am more in the camp that leaders are born category, but I will say that I have met people who have improved their leadership skills and talents over time.  Goleman put some of it down to maturity, the combination of age and experience.  I can buy that. 

Even if the measuring tools at the moment have some challenges in making the case for either EI or external evaluation (accreditation or proficiency testing), it does not mean that either hypothesis is wrong.  It can also mean that the systems of data are in constant change and have a huge number of variables which the current measurement tools have difficulty in addressing.  From my personal perspective, at the end of the aforementioned paper, I mentioned that just because we can’t prove the value of accreditation or PT is not a good reason to stop either.  I suspect the same is true for trying to be objective when seeking good leaders. 

I have been in sufficient laboratories to know and understand and buy-into the reality that some laboratories make more errors than others and some laboratories work to prevent errors from recurring while others do not.  Laboratories can learn about Quality and implement Quality effectively.  And while I can’t prove it, it is my observation that leaders that permit and encourage and motivate the creation of a Culture of Quality are better leaders of better laboratories.  

Leaders that don’t give a damn are not.  

I'll have a Grande Latte with that Proficiency Testing, please.

I have mentioned before my views on the close associations between Quality and Leadership and Innovation.  The other day I was watching television in a mindless sort of way, when I got to see a telecast of Howard Schultz, chairman, president and CEO of Starbucks giving a presentation at the Vancouver Board of Trade.

Now I know that Starbucks coffee is not for everyone, but one would be hard pressed to not recognize the company as pretty much a world wide success.  Recently I was in Ankara Turkey and still had my daily double espresso. 

Schultz has an interesting story with Starbucks because he built it up the first time, and left the company when it decided to chase growth over quality, and then was asked to return when the company was going sour in a hurry.  Three years after his return, the company is back on top.

During this presentation he talked about several key issues.  The first was that successful companies are driven first from their core principles.  Second, that human resources have to be at the center of decision making.  Successful companies ensure that their staff are front-of-mind.  Third, that in the “eco-system of enterprise”  companies that give back to customers succeed.  Not giving back in the sense of kick-backs, but in the sense of being a contributor to education, outreach, leadership and support. 

And fourth that innovation that is visible to and beneficial for the customer is critical.  Companies ignore the opportunities of innovation at their peril. 

Customers are no longer interested ONLY in price.  Customers are more comfortable when they perceive that they share your values and see you as part of a “thread of trust”.

Now I understand that most of this is way outside the scope and authorities (but hopefully not the interests) of the public sector institution based medical laboratory.  The drivers of decision making in the public sector institution may not see themselves in the same way as Starbucks does.  But it seems to me that the core principles are pretty central to every successful organization.

And for Quality Partners including Standards Development Organizations, and Accreditation Bodies, and Proficiency Testing Providers, and Reagent/Equipment Suppliers, and to some degree, Quality Consultants, the iteration of principles has to be absolutely “spot-on” advice.

Organizations need to know what they are good at and what their core values are.  If they don’t know, then how can customers know what to expect. 

And trust is critical.  To the extent that your customers have control, they will stick with the folks that they trust.  But watch out when the thread of trust is broken.  When you are perceived as only about growth and money and serving your own interests only, and not about providing support, then problems will blossom.

And then comes innovation that is visible and relevant to the customer.  Are we writing standards that matter?  Are our proficiency testing samples a boon to quality improvement and to today’s needs for continuing education?  Along with reagents and supplies, do we provide the element of real innovation that is meaningful to the laboratory?

Are you a value-add, or just the same old-same old?

CMPT spends a lot of time, effort, energy, and money one these very issues for year.  We like to think we are successful, although not quite to the same level as Starbucks. 

If you visit www.CMPT.ca you can see our latest Annual Report for 2010-2011

Ariely and Astion - bringing meaning back to the laboratory worker

I am reading “The Upside of Irrationality” by Dan Ariely (2010.  HarperCollins Publishers) and came upon a chapter that struck a chord.  It was one of those very satisfying moments. 

Ariely is a psychologist and behaviour economist; one of those guys who works in experimental design to address basic issues in behaviour.  In this one study he was interested in what motivates people to work diligently. 

The experiments involves asking folks to build some complex characters using the toy building blocks Legos or playing word games on paper.   The study design is essentially giving money for completing the task (either building something or completing the word game) giving more money for completing, but giving but progressively less money each time it is repeated.  The variable is whether the person sees some additional recognition.  In one scenario, the person’s building or word game is saved with they name, in another their work goes into a pile, and in the third, their work is shredded immediately. 

Turns out that folks will repeat the task multiple times, even though they are making relatively less money as they continue if they see the characters are connected to them by name or by preservation.  When their output is ignored destroyed, they do less repetitions, and follow the procedure with less accuracy.   People work more and more accurately when their work is not ignored or dismantled.  People work better when their work has meaning.   

When we put it that way, there is no surprise here.  But this begs the question about working in a modern medical laboratory.  One person receives a requisition and enters data into a computer, over and over.  Another takes the sample, now identified by a bar code and puts it into a tube or cuvette over and over.  Another pushes a button on a machine that makes the machine test the sample.  And another transcribes the machine result into report.  If workers name is collected, it is not for recognition, but rather who to blame when there is a problem.  This is a system that might make Henry Ford or Frederick Taylor happy (2 guys that built assembly lines) but it is tough to find a lot of meaningful recognition in this type of work.

In the microbiology laboratory, the technologist today receives a set of plates that have been incubating overnight, disconnected from the sample, disconnected from the requisition, disconnected from any clinical information.   Total disconnection. 

At our POLQM Quality Weekend Workshop, Mike Astion from Seattle was presenting on human resource issues in the medical laboratory and discussed this very scenario.  He was talking about laboratory workers being disconnected from their work… bored and making mistakes.  We need to connect the technologist back to the real live and living patient.  We need to connect the technologist with a reason for feeling like they are contributing to patient care.  We need to have meetings where the laboratory people actually meet and talk with the patients.  We need to make the laboratory people feel connected and meaningful. 

We need to ensure that laboratorians are clinically relevant.

There are all sorts of ways to make the reconnection.  In one laboratory that I have visited in Tanzania, they have put patient’s pictures on the walls.  Clinical technologist positions send the technologist out to participate in ward rounds.  Clinical-laboratory conferences with patients participating. 

These are all old ideas that were common practice in the 1960’s.  It is time to bring them back.

I love it when information from many sources all comes together.

Quality is never an accident...

I am giving a number of presentations in the next little while, so I thought I would look for some quotations that might stimulate some juices.   One that comes up frequently is “Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives” ascribed to a William A. Foster.    I suspect that all of you have heard this one at one time or another.

My first thought was it was typical a most feel good quotations in that it contains some grains of relevancy, and is based on good intentions, but is pretty much self indulgent.  I agree about quality never being an accident and the part about taking effort and direction, but the rest is more than a little excessive.   It might be something that Deming might have thought, but never would have written (too pedantic).  It is the sort of thing that folks quote, but rarely if ever actually say.

What interested me was that I have never heard of William A. Foster in the historical trail of quality; so I turned first to Wikipedia to at see what I could find.  What interested me was that the only person with that name cited is a fellow who earned a Medal of Honor for falling on a grenade in the Battle at Okinowa in 1945 when he was 28 years old.  An admirable act to say the least, and perhaps an action that someone with grand thoughts on quality might say, but unlikely considering he worked as a factory laborer prior to his stint in the Marines in WWII.    Perhaps the quote was not so much BY William A Foster, but more ABOUT him.  That being said someone was convinced that this William A Forster wrote the quote and linked his picture to the quotation.

Turns out that I was not the first person ask the question.  One research found an advertisement in the New York Times for an advertising company with the exact quote in 1939.  At that point William A was 21 years old, so that nailed it for me that whoever the writer was, is was not William A.

With a little more searching I found another possible and more probable candidate.  Turns out there was another William Foster, born in 1879 with the middle name Trufant.  Trufant was probably his mother’s French family name.  Born in Boston, educated at Harvard (1901), Professor in English and Argumentation (Debating), PhD from Columbia in Economics (1911), and an author of a series of  books on Money, Profits, and Business, most of which were written in 1928, which was when he was 49, and about 11 years before the aforementioned advertisement.

If I had to chose between William A,  a factory worker and Marine who died valiantly  in a war at a very early age, or William T, a pedantic type guy with a background in English studies and debating and economics,  as the likely author of a grandiose view of quality, I would personally guess the latter.  

But I could be wrong.

Quality Education: what's it good for?

We are putting together a Master’s in Laboratory Quality Management which we expect will be available both in an on-line option and an on-site option.  The on-line will primarily be for folks who are working and intend to continue to work.  The on-site will be for folks who want to take some time away and spend some time doing primary research in medical laboratory quality.  I will continue to write on the subject as the program becomes ready for prime-time.

In the process of putting the proposal together, we did a survey of the folks who participated in the UBC Certificate Course.  Rather than invite and re-invite folks to respond to the survey we made the decision to take the responders from the first pass.  Both approaches can be equally useful, as long as you take methodology  into consideration as you interpret the results.

So after 5 days we gathered about 25 percent of course attenders.  The distribution of folks from across British Columbia and across Canada, and from outside Canada were essentially the same as the total group.  In addition the responders  equally included participants from the early years, the middle years, and the recent years, and few from the current group.   As we did not put any pressure on this group we can interpret this as a reasonably representative group.

Of interest to us was that about 90% belief there is a market for people with a Master’s degree today, and that the same percentage see that the market will be much stronger over the next 5-10 years.  That is what I believe too.

One finding that interested me, and disappointed me at the same time, was that only about 65% of responders currently are holding positions involved directly  in Quality.  We didn’t ask how many had held quality positions but had changed jobs, in large part because that was not the primary point of the survey  But what was interesting was that folks who had taken the course but were not actively engaged in Quality positions still believed there are opportunities out there, and that the market will continue to get stronger.

Which all got me to thinking; there are all sorts of positions for people interested in and trained in Quality.  The most obvious position is as part of a quality team or a part of laboratory  management.  But there are lots of other places as well.  There are positions with all the quality partners, like the proficiency testing group and the accreditation bodies.  There are positions within public or civil service, especially within the Ministries (or Departments) of Health and the health authorities, where knowledge of laboratory quality is important.  There are positions with service and equipment and reagent suppliers who need to be aware of validation, verification, stability, and measurement uncertainty.  And there are consultant positions, especially as we in Canada move more and more towards official inquiries for laboratory error.  And importantly there are increasing opportunities within education with the schools of technology, as well as the medical schools.

Bottom line appears to be that Quality in health and in particular the medical laboratory is a growth opportunity; today and tomorrow, and from the folks who responded to our survey, for the next 5-10 years plus.

Resident Quality Seminars as Adult Education

A few weeks ago I wrote (See “Communicating Quality and the Principles of Adult Education - January 30th 2011) that adults learn what they want, and  how they want and accept the knowledge if it makes sense and is consistent with what we already know.  The educator needed to be seen to be organized and pragmatic and relevant and interesting.  If adults are motivated they learn better.  

So with this in mind, can I make any objective comments about my own teaching capabilities?

I got back the results from my Resident Seminar Series.  
 
Background 
To summarize, I put on a seminar series for anatomic and general pathology residents.  The series begins the week after New Years and my sessions start at 08:00 AM.  A draw to the academic half day program is that they get a free breakfast when they attend.  
Before I start the seminar series  I create an anonymous on-line survey that includes a series of 10 questions on quality facts, along with some demographic information.  I then present 7 hours of seminars over 4 sessions and give 1 hour to a guest presenter, and after that asked the group to respond to a second on-line survey which asked the same questions as before and added some additional comments on the series based on a 7 point Likert ranked scale with a maximum value of 6.0

Attendance
The pre-seminar survey had 25 responders.  
On average there were 29-31 attenders to the seminar series.  Nearly everyone attended all 4 sessions.
The post-seminar survey had 14 responders.

Findings
So my first point.  Adult learners do what they want and respond to surveys if there is something on the table.  After the series we were able to get 14 responders (despite repeated requests).  Not getting a better response rate in the post-survey was annoying, but it is what is is.  

My second point:  There was improvement in the responses to all the fact based questions.  There was significant improvement (yates corrected p<0.05) in 2 questions.

My third point:  The responders found the information relevant to their career (5.5/6.0)  informative (5.36/6.0), relevant to their residency (5.29/6/0), and relevant to preparation for examinations (5.07/6.0)  The weakest response was when the group found the information interesting (5.0/6.0).  

Interpretation.  
Overall I can this a success.  Not an overwhelming success, but a success none the less.  

What was encouraging was that after the series, one resident  approached the hospital quality manager to get engaged in a project, and one resident approached me on a similar topic.

The increase in knowledge performance was ojectively positive and in part significantly so.  And there is a powerful opinion and recognition that knowing something about quality is important in a laboratory career.

Discussion and Conclusion
The objective measures point to the seminar series as a measurable success with opportunities for improvement.

Teaching my on;line course is the ideal adult education situation.  The participants seek us out because they want the information.  There is money on the table.  They feel free to participate actively.
With residents, they are present because they feel required to be there, even if they don’t care.  At worst they still get a free breakfast.  There is no money on the table.  They feel free to drop out if they are not being entertained.   

Note to myself:  
Look forward to doing the seminar series again, maybe next year, more likely in 2 years.  
Make some changes to beef up interest.  
And importantly don’t take the weak response rate too personally.  If they really thought the series stunk they probably would have taken full advantage to let me know.  

PS:
The information will be presented more completely and formally during the POLQM Quality Weekend Workshop in June.  There will be an education breakout session.