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Davis Balestracci

Management

Some Reflections... and a Challenge

Time to stop doing the wrong things badly

Published: Wednesday, September 13, 2017 - 11:03

I have reached one of those life landmarks (receiving my Medicare card) and have been reflecting back... a lot. I will remain every bit as passionate about improvement and don’t think I will ever formally retire, but I also doubt I will have W. Edwards Deming’s tenacity to keep at it until I (hopefully) turn 93.

I’ve been writing columns for Quality Digest for more than a dozen years. Are all of my topics still relevant? I believe so.

What about progress in improvement? Going back even further than 12 years, I also reflected on and concluded that despite all the mind-blowing technological advances that have taken place during my 35-year career, improvement progress remains glacial.

Tick... tick... tick.... Is the next “magic bullet” fad du jour lurking to create further distraction from true root causes?

David Kerridge, one of most brilliant Deming thinkers in the world, had a wonderful quote: “If we are actually trying to do the wrong thing, we may only be saved from disaster because we are doing it badly.”

And the last few years, especially in healthcare, seem stuck in “rearranging the deck chairs on the Titanic.

Good news: We’re evolving from Neanderthal to Cro-Magnon quality

Fortunately, “quality” has made a necessary evolution from “Neanderthal” to “Cro-Magnon.” This has resulted in a quantum leap in activity, especially bolt-on quality project activity. However, the overall effect has been like speeding up evolution by 10,000 years—it’s progress, I suppose, but in the larger scheme of things, one could hardly call it the bold, needed (r)evolutionary progress that, for almost 30 years, has been continually talked about (and talked about, and talked about) with empty-calorie, passionate lip service, especially the topic of “leadership.”

From what I have observed, technology—especially in the areas of data and allegedly intelligent statistical software—has seriously compromised critical thinking and keeps people naively and unwittingly mired in “doing the wrong thing badly”... and doing it faster.

Many alleged improvements have gotten processes only to where they should have been in the first placethat rate of improvement will not continue. W. Edwards Deming was also emphatic that this is not improvement.

To adapt the famous quote from James Carville: “It’s the people, stupid!”

Despite what you might hear at sanitized conference presentations or show-and-tell webinars, one thing hasn’t changed: Cultural resistance to any change remains “disgustingly normal” and fierce.

The dam of repressed emotions inherent in a Neanderthal Theory X environment has now burst. This intense emotional energy is the vital fuel needed to drive the improvement engine of process, tools, and good technical and administrative information. Harnessing and improving the quality of this fuel is a key element in any revolutionary transformation process to true excellence.

Deming’s famous 14 Points for Management reflect this. A new, more Deming-based quality mutation called “built-in improvement” has been trying to evolve for more than 30 years. Isolated appearances of this species have been reported, but they are fleeting; natural selection has not been kind so far. I just hope it’s not too late.

“If there are 12 clowns in a ring, you can jump in the middle and start reciting Shakespeare, but to the audience, you’ll just be the 13th clown.” —Adam Walinsky 

With the internet’s many self-appointed, nonvetted, incompetent alleged experts and ubiquitous, easily available information, software, and expensive, “impressive” certifications, a complicating need has evolved for everything to be bigger, better, faster, more, now... and free. Too many people fall prey to the easy seduction of all this nonsense. But who can blame them with this constant bombardment barely giving them time to think at all, never mind critically? Besides, this is the behavior that gets rewarded.

Painting by the numbers won’t produce great art. Why should improvement by the numbers produce great organizations?

Improvement by the numbers includes:
• Going through the motions “by the numbers,” ticking boxes on a checklist and passing an exam that might involve a token project to get a certification
• Using “big data” that is the “continuous recording (of) administrative procedures” (CRAP) to manage

“Quality” and “leadership” remain mired in tiresome, hopeful platitudes repackaged in a program du jour to look like easy answers. Attention-deficit executive arrogance remains the root cause of glacial progress.

Executives need to improve the quality of their emotional fuel as well. For true excellence, they must eventually realize that you get great employees by being worthy of great employees. 

Meanwhile, for anyone whose job involves improvement, it is time to realize that part of your role now formally involves working around this arrogance. It can be done.

If you don’t agree, I’ll be blunt: Get out of improvement! Your organization has managed to induce “learned helplessness” in your improvement efforts.

Too blunt? OK. Try this: Look at your job through a lens of personal accountability by reading John Miller’s book, QBQ! The Question Behind the Question (TarcherPerigree, 2004) and deciding whether you want to accept or still back away from my challenge.

As Deming said, “A good company will take five years to turn around. Most will take 10.” His improvement approach via leadership remains the most robust approach to true transformation. Yet his radically brilliant, visionary mutation beyond Cro-Magnon quality continues to struggle for survival—and at the moment may actually be moribund.

Despite my passionate belief in it, and its enthusiastic acceptance from results-based demonstrations in my seminars, I continue to struggle to sustain that enthusiasm in post-seminar participant behavior as they go back to daily cultures that grind them down to learned helplessness via tolerated “cultural handcuffs” and resistance.

My dear readers, aren’t you getting tired of being perceived as the 13th clown?

The following quote—with the help of Deming’s and Joseph Juran’s timeless wisdom—has been an ongoing inspiration and guide in the ensuing 28 years since I first heard it at a 1989 conference: “The words ‘statistical’ and ‘quality’ should be dropped as qualifiers because they should be givens.”

What behaviors do I need to change?’

Isn’t it time to try the new, built-in improvement mindset with a goal of building a critical mass of mutations going far beyond Cro-Magnon qualityand doing the right things right... faster?

Let me give you a concrete, two-part assignment to get started.

Part one
Print out, visibly post in your office, and start each day by reading the following passage by Jim Verzino and taking personal accountability to observe and begin to address its symptoms. Perhaps use it at improvement meetings as a warm-up to ask, “What do we continue to tolerate as barriers to progress?”

“Nobody plans for poor quality management solutions. But over time, harmless little decisions can derail a quality management system.

“Each time we choose to sacrifice the good of the system for one person, or allow an ineffective, outdated legacy practice to continue, we take small steps toward lower and lower standards.

“When we have a culture that puts quality and environmental attainment at a lower priority than feelings and keeping the status quo, slowly we make the hundreds of decisions that eat away at total performance....

“Every week tens, if not hundreds, of little decisions like these are made in a large company. Any one decision will not make or break the system. However, hundreds of decisions being made with a priority on entrenched personnel or ideas rather than the higher goals of continuous improvement will bring the system to its knees over time....

“In the end, nobody plans to have poor quality or environmental performance. It sneaks up on us... [as] the sum of so many bad decisions.”

Part two
Order, read, and apply the concepts in QBQ! No excuses—it takes less than one hour to read. (I have no financial interests in Miller’s book.) And healthcare folks: Declare a moratorium on “tools,” books, and obtaining certifications.

I smile as I think of some who may read it and sincerely say they want to apply it to their jobs, but for whatever reason, insist it’s impossible. If that’s you, then read this sobering recent blog post by Miller.

Most of you will say: “Boy, do I know someone (else) who needs to read this!”

I was guilty of both of these when I first read it. As Miller notes in his afterword: If that’s what you’re thinking, go back and read it again.

There are no more excuses for glacial progress.

I guess I’m becoming old and cranky (even more of a curmudgeon, if that’s possible). I find I’ve gotten tired of being the 13th clown and told, “Oh, but you are a very good 13th clown!” So I’ve decided it’s time to (affectionately) turn some of my crankiness on you. 

I apply QBQ! every day to ask:
1. Is that a perception I want people to have? (No)
2. If that perception continues, am I going to be effective? (No)
3. What can I do to change that perception? 
• I’ve been in a constant PDSA cycle trying ways to help people succeed with eye-opening results when they go back to their toxic work environments.
• I’ve written Data Sanity (mgma, 2015) as a leadership road map for excellence by creating a common organizational language to engage leaders in everyday dialogue with their organizations.

Hence, my challenge today: I need you as a colleague. (“I know nothing; you know too much. That makes us a great team!”) Are some of you willing to work together with me to create that mutation of built-in improvement where the words “statistical” and “quality” are dropped because they are givens?

Data Sanity will be our laboratory. And I will be a relentless mentor who is 100-percent committed to your visible success—and to bringing back the “laughter and sense of peace” mentioned by one of my seminar participants.

Until next time (and do your assignment!)....

Your kindly curmudgeon,
Davis

Discuss

About The Author

Davis Balestracci’s picture

Davis Balestracci

Davis Balestracci is a past chair of ASQ’s statistics division. He has synthesized W. Edwards Deming’s philosophy as Deming intended—as an approach to leadership—in the second edition of Data Sanity (Medical Group Management Association, 2015), with a foreword by Donald Berwick, M.D. Shipped free or as an ebook, Data Sanity offers a new way of thinking using a common organizational language based in process and understanding variation (data sanity), applied to everyday data and management. It also integrates Balestracci’s 20 years of studying organizational psychology into an “improvement as built in” approach as opposed to most current “quality as bolt-on” programs. Balestracci would love to wake up your conferences with his dynamic style and entertaining insights into the places where process, statistics, organizational culture, and quality meet.

Comments

Glacial Progress of Improvement

Unfortunately, this lack of progress is due to how we think about improvement and how we teach it. Two and four week certifications teach that improvement is slow, cumbersome and complex, rather than fast and agile.

All this drum beating about top leadership involvement only works half the time. (1 Sigma)

Be the leader you want to see. Stop waiting for someone to give you permission. Start using the tools and making improvements wherever you are.

Stop trying to do it "the way it's always been done." Start finding and using faster, better, cheaper ways of improving processes without all of the jargon and hype.

Stop teaching people things they don't need to know to solve problems they don't have. Don't use tools you don't need.

What we have here is 100 years of tradition, uninterrupted by progress. Progress will not change until we do.