Cracking the Code on Quality: It’s All About Living Your Values

Recently I was asked to put together a “maturity model” for quality in hospitals-- what an “evolved” hospital looks like when the best quality of care is performed reliably and when patients are truly engaged in their care.

And while I would hope every hospital is already very mature in this, the data show us that most hospitals have a long way to go. Truth is, many academic and governmental agencies give hospitals a “C” rating on this front! (To check out a hospital’s rating, go to The Leapfrog Group’s website.)

In fact, the 3rd leading cause of death in the USA is medical errors! Compare that to other industries which have cracked the code on quality, such as the airline industry. According to a study done by the Massachusetts Institute of Technology, any time you board a flight on a major carrier in this country, your chance of being in a fatal accident is one in seven million.

So why is this? Because hospitals are complex, the problems leading to quality problems and poor patient engagement takes time and effort to fix, and team work is needed to solve these problems. And as it turns out, nurses and doctors are generally not trained to be change agents!

According to Harvard Business Review and others who write on this topic, a whopping 50-70% of quality efforts fail or in some way or do not meet the stated goal of the project. Whether these efforts are utilizing principles such as “total quality management,” “reengineering,” or “process improvement,” does not matter. The failures still come fast and furious.

And it’s not for lack of trying. We spend a lot of money on trying to improve health care performance. Hospitals have entire staffs of “quality improvement” professionals. And yet, many hospitals still only get a “C” performance.

I believe the core problem is that we are focused on short term fixes rather than real change, which often takes time and requires a different mindset and skill set.

According to work done by William Bridges, change is something that happens to people, whereas transformation is an internal process, it is something that happens within people. Transformation involves seeing and perceiving the problem differently-not as something that must be “fixed,” but rather as a transition of letting go unhelpful attitudes, beliefs, patters by developing new ones.

Real change requires re-thinking the habits and behaviors of an entire organization so it can truly transform. An organization needs to be ready to change to a transformative mindset, which is a constellation of beliefs that value team-based respect, learning and performance. These values need to be lived as daily norms. Norms are beliefs held by a group (or hospital) about how its members should behave in a given context. Norms are the informal understanding that governs local behaviors. Think about the saying ‘Culture eats strategy for lunch’ and you’ll understand norms.

The way such norms and values would be seen in action in a transformed and matured quality organization would be if the hospital’s leadership have a structure for measuring and addressing problems and fixing them in a real-world, “right now” manner. Where the best care for the patient is the primary reason for doing things and any exception to this is not tolerated. Where there is a forum for all staff to take their ideas for improvement without being punished by their manager. Where senior-level committees welcome input from non-members--and non-members are not made to feel shut-out and intimidated. And that “the way things are done around here” is something people say with pride, not with feelings of defeat.

Remember people learn what they live so if change and improvement efforts aren't genuine, real quality improvement will be elusive or, at best, slow to arrive. Health care providers and leaders often have a goal for a better work place where exceptional patient care is delivered. Taking the time to look beyond the standard approaches to create a goal-driven culture of collaboration, respect and dignity is the only way to get us on the road to a mature model of quality improvement.