How do you eat a whale? The old idiom says one bite at time, but the truth is, even if you try your best, work your hardest, and focus on the task at hand, it's just too much. In my work, I've seen this struggle play out in clinics, public health departments, and hospital units alike.

Addressing big opportunities certainly requires a plan to know which bite to focus on now, which bite comes next, and a reasonable schedule to finish each bite until the end, but more important than the plans are the people:

• Dedicated teams with the right skills to do the work

• Individuals who have manageable and meaningful workloads

• Standardized and efficient methods to approach the work

• Collaboration and Communication

I'm talking about an identity that drives organizational decisions, sustainability to lead with respect for people, and always striving to be better -- that's what a culture of quality is to me.

Unfortunately, culture is a word I've heard overused and/or misused by organizations on their journey to implement a quality program. Every time I hear it I'm conflicted. My first reaction is to cheer inside because to maximize all the benefits of quality long-term, there has to be a shift from simply filling out PDSA worksheets or sharing a control chart to an environment where EVERYONE has the passion, skills, resources, and empowerment to make quality THE personal and professional priority.

However, my next reaction is to take a clear headed approach to what culture really is…because when I explain the details, I hear things like, "Isn't that the responsibility of the quality people?", "We don't have time for THAT!", "I need to engage people, not put something else on their plate", etc. Having a clear definition of what your organization should be, and even crafting a strategy to achieve that vision, is easier said than making all the changes to ensure everyone has the training and support they need. Even with the right skills and resources, systems must be in place for people to be contributors to the clearly defined success of their customers, organization, and themselves, using quality improvement methodology. I'm not going to sugar coat it - it takes a lot of dedication and commitment, and it's not easy to always get right.

Before starting any culture transformation, there has to be a "gut check" that involves really hearing the voice of patients, stakeholders, partners, and employees at all levels. It's a tough balancing act to prioritize transformative and feasible changes that will excite your champions without alienating those resistant to change.

People need to see the why, the what, and the how. Give them a clear path with defined behaviors at each checkpoint. Everyone needs to see that they are valued, understand why they are asked to be doing new things, and know what a win looks like. Culture change is not top-down. There has to be an element of solving the pain points, creating opportunities, and rewarding a job well done at every level. In fact, leveraging dissatisfaction with the old way can be a powerful motivator to change. Key "gut check" questions start with asking, "Why Change?", and then asks:

What happens if we don’t change?

What will change?

How will it change?

Knowing what has to change, and getting the buy-in to make those changes to further a culture of quality are major milestones. This pre-work is necessary because improving culture shouldn't be a sweeping change. Instead, it's a journey of transformation that people are prepared for. In the next post, I will walk through some considerations for building a culture of quality.