Chasing the Rabbit: Official Blog by Author Steven Spear

The question was asked; In times of budgetary pressure, what quality initiatives should be sacrificed.

Asking that asks the wrong question.  The right one is asking what can be done to better design and operate care critical processes to advance quality, affordability, and access simultaneously.

The first question reflects unwarranted arrogant pessimism, the latter better justified humble optimism.

Here is a fuller explanation.

Many people operate under a false premise: That they have to make decisions when confronted with unavoidable tradeoffs.  Quality versus cost, safety versus productivity, etc.

The problem with the mindset trade off is that it is rooted in an arrogant pessimism.

Quality, safety, cost, yield, responsiveness and so forth are all derivative measures, the consequence of how the complex interactions among people and technology are managed in the creation of value.

To focus on trade offs–that to get more of something means you have to give up something else–means you assume you are extracting as much cumulative value out of your work as possible.

To believe that true, you have to assume you already know all there is to know about how that work can be done–an arrogant view no doubt.  Or, you have to assume that even if there is more to discover, you’ve maxed out your own capacity to learn.  A fairly pessimistic framing.

An alternative is humble optimism: the humility to acknowledge that whatever you can achieve today, is less than what is possible according to laws of chemistry and physics.  The optimism that with effort, openness and engagement, you can move from where you are to better understanding.

The former posture–arrogant pessimism lends itself to confrontation.  Someone’s gain has to be someone’s loss.  The latter posture–if practiced lends itself to cooperation and collaborative achievement.

Let me conclude as succinctly as possible: In times of stress, any leader not asking and demonstrating how to accomplish more with less is not doing her or his job.

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