The Culture of Quality - Part 2
How do we make our culture one that is built on quality?
In part one, we covered the necessary planning, and now we get to the tough part. You know what needs to change, stakeholders are at least cautiously optimistic, there is commitment to introduce changes to our systems (technology, processes, methodologies, people) to remove limitations, but that's still only half of the equation.
As I mentioned in the prior post, culture is all about people. So when we talk about improving culture, it means changing behavior. After all, we can change systems, but if individuals and teams, from leadership on down, still behave as if the old protocols and policies are in place, a new culture will struggle to thrive, even WITH the knowledge, willingness, and resources to do so.
So how do we change behavior? I'll spare everyone the meta-analysis of holistic change management methodologies, and break it down simply -- just remember the why, what and how!
Why Change? Keep reminding people of the value-driven purpose of the change.
What barriers does our change lessen? Specifically call out those pain points that changing addresses
What things helped the barriers stay in place? What resources and actions (or inactions) allowed those barriers to exist? Reinforce the things that need to stop, and keep it focused on process, not people.
What should we do now to reach our shared vision? Empower people to have a voice in deciding what the new rules should be to achieve the collaborative goals.
Remember, a culture of quality requires a long-term commitment to quality improvement that relies on systems and values embedded in your organization - not on individual champions. You can't rely on high-performers alone. It means a new way of working for everyone, including skeptics, laggards, and those who have a vested interest in the old way of doing things.
The idea is to shift from people doing tasks, to people achieving goals that are aligned with what your patients need, expect, and value.
Consistently and preemptively delivering services and supporting and empowering staff with capability, capacity, and authority to meet those expectations is an important first step. The vision and infrastructure must be complemented with regular measurement of the degree to which your patients’ and customers’ outcome expectations are achieved, and continuously seek to improve them.
What needs to change to achieve a culture of quality based on improved systems? Here are some things that come to mind for me:
Methods: Policies, processes, protocols, and procedures; It's not just updating what you might already have, it's finding out which ones don't add value, and creating valuable ones that might be non-existent.
Resources: Investment in new technologies and infrastructure that support future goals may be necessary. This can be a hard sell - having the tools to support specialized needs for specific goals are arduous to acquire in the age of "Enterprise Solutions". It might have to be incremental. While these things certainly make life easier, I'm always amazed at what I can accomplish with sticky notes and a team of good people.
Hiring: Does HR recruit specialists with the right keywords instead of the most qualified collaborators? Does the process bias a safe choice, or is there balance to include those with less experience, but the highest aptitude and potential to grow? A culture of quality doesn't mean layoffs or reductions in force, but new hires are an opportunity to bring those who can fit the mold, or show aptitude.
Performance reviews: Are they currently inconsistent, one-sided, highly variable, and encourage narrow individual completion of tasks with vague relations to impact, goals, and value? Those need to shift to 360 reviews that include rich qualitative detail, and transparent, agreed upon, and valuable quantitative metrics. My time in government was always frustrating because I saw people in the same role, in the same grade being held to completely different standards.
Where the work happens: This is particularly relevant in the current landscape with increased telework and hybrid teams. How does the team feel? (e.g. isolated, insufficient thought to transition to virtual processes). In the current age, flexibility is key. If you have good processes and great people in place, you don't have to worry as much about "butts in seats".
Mindset: If the team is still rooted in old ways of doing things - if they have a vested interest in their niche - what can you give them? You can’t expect people to change without reason to do so. Additional skills, more empowerment, and less frustration can be great motivators.
Budgeting, reporting, tracking, monitoring, evaluation, etc.: Instead of being based on counting widgets and tasks, start tracking the creation of value, and its throughput from steps, process, outcomes, and goals.
Working collaboratively: Today, the challenges we face require teams that can make decisions collaborating in real-time, instead of from a static work-plan that has to be blessed by management. Literally, lives hang in the balance, sometimes this means working together towards a goal in a way that goes against the grain or doesn't have consensus (this might be a good topic for a future post).
Teams: Create teams that are informed by mission, vision, and goals, and work collaboratively and independently to manage the associated responsibilities and timelines, instead of horse trading based on office politics.
Workload: Calculating and accounting for the "invisible work" in each program and project -- things like coordination costs. Don't give the high-performers the most work -- you're just burning them out and wasting their talent on non-value added tasks to stay in the loop on everything they are assigned to do.
This is a lot, and it's going to be tough. You might be thinking these changes will alienate everyone from HR, to managers, to seasoned veterans. That's a valid argument, so the messaging is really important. You're not a bad person if you were responsible for creating or enforcing the things we are trying to change. In fact these are not bad things per se, just not the right things anymore for our current vision for ourselves and our patients. Beyond that, you have to give folks the tools to grow, and hope they accept the challenge.
What is to gain from this work? A culture of quality gives the organization a clear identity, a customer-driven purpose, exceeds benchmarks and standards, is efficient, is strategically prepared, has an engaged workforce, and can sustain excellence. For those that have the patience and perseverance, the benefits to furthering a culture of quality are tangible.