Chasing the Rabbit: Official Blog by Author Steven Spear

Can organizations sustain their ‘quality’ efforts in the current economic environment?  This question is being asked in all sectors—industry and healthcare, high tech and heavy industry, manufacturing and services.

For great organizations, the answer is not only “we can!” but also “we must!”  For others, there is hesitation and doubt. 

Why?  How these two groups think about the question reflects fundamentally different assumptions. 

Great organizations start with the humble but optimistic assumption that there is always room to improve and innovate the products and services they offer and the processes and systems on which they depend. 

Therefore, they are always asking: How do we do better?  How do we achieve higher quality, better access, and a whole host of other goods at far less cost so resources are put to much better use? AND how do we do so with even greater urgency when resources are tight? 

Also-ran organizations start with the arrogant but pessimistic assumption that whatever they do is done as well as possible, and that there is no room for improvement. 

Hence, they are always asking: How do we make the trade-off between quality and cost, between safety and cost, and so forth. To get something good we have to give up something good in exchange.

The Data: 

The evidence is overwhelming that the assertions, assumptions, and prescriptions of the also ran organizations are false and those of the great, high velocity organizations are true.

 These are just some examples from recent health care news clippings: 

• Reductions in post surgical complications due to the simple use of checklists in operating rooms (Boston Globe Jan 15), 

• The improvement of care using IT to allow better use of current, consolidated information (NY Times Dec 27), 

• The reduction in ED diversions by better treatment-process design and management (Boston Globe Dec 24).  

Other documented examples:

• Complete elimination of surgical site and central line infections at Pittsburgh Regional Healthcare Initiative hospitals, 

• HUGE reduction in human suffering by encouraging ’standard work’ for the planks in the IHI campaigns

• Great savings Virginia Mason Medical Center has scored through process excellence–quality improved, costs reduced and entire costs avoided. 

Another thought:

Healthcare is not alone in wrestling with these antagonistic, contradictory, and mutually exclusive perspectives. Other industries are plagued by those who think life’s challenges are largely zero sum decisions rather than opportunities to discover how to grow the pie.  

For instance, I was recently at a auto parts company that supplies Toyota, Honda, Chrysler, Ford, and GM (blog post about this).  The context of the visit was a workshop we helped Toyota create for senior supplier leaders–company presidents, plant managers, VPs for Design and Development, VPs for Manufacturing, etc.  

Some five or six companies were represented–20 some odd senior leaders in all.  The purpose was to use a week of process excellence boot camp as the means to leveling up the skills of the senior leaders so they could accelerate gains in their own organizations.  

While this ‘grow the pie’ approach was being tried, the plant manager shared a striking contrast.  One of his Detroit customers was pre ordering parts far beyond their sales needs.  Why? As best as he could figure, they were trying to get material in advance of a possible bankruptcy filing so as to get them for free.  For them, the pie is fixed in size, so to eat more you have to ensure someone has to eat less. No wonder they’re now first in line for a welfare check.

Related posts:

1. Asking what quality initiatives get sacrificed under budget pressure asks the wrong question…
2. Measuring Therapeutic Effectiveness and Cost–One Part of Better Care for All
3. Incident Reporting Systems: Inadequate tool for quality and safety…
4. Krugman concedes main objection: In fact, more care needn’t cost more…
5. BusinessWeek.com Video: High Velocity Lessons in an Economic Downturn