What Are You Tolerating?

Cultures can’t be built on nonsensical data and wasted effort

Published: Thursday, February 14, 2013 - 12:31

What exactly is “culture?” As Jim Clemmer puts it, “Culture is ‘the way we do things around here’… especially when the boss isn’t looking.”

As I asked in my January 2013 column: Do cultures’ (unwritten) expectations unwittingly create the leaders they have? Are various guises of “traditional management” still the norm?

Any organization dedicated to true transformation must make the necessary transition from a “quality as bolt-on” mindset to “improvement as built-in” mindset. For this to be successful, formally addressing issues of “culture” is a given.

In a recent post in Talent Vanguard, Jane Watson, an HR manager in the nonprofit sector, talks about concepts from the social sciences that can be used to frame thinking about what is meant by “organizational culture.” Watson writes:
Culture is enacted. Culture is continuously created by members of your organization, through their day-to-day participation.
Culture is “how we do things here.” It provides members with (largely unspoken) rules for how they should behave to gain and maintain social “membership” in the organization.
Culture is manifested in a variety of ways. These include:
• Language—shared words or labels your organization uses for things
• Rituals—such as town hall meetings, the summer BBQ, and award ceremonies
• Dress code—how people are expected to dress in the course of doing their work
• Symbols—the meaning attached to corporate symbols
• Decision making—how important organizational decisions are made and communicated
• Conflict resolution—how conflicts are expected to be handled, discussed, or avoided
• Status—who is recognized and esteemed, both formally and informally

So, as Watson summarizes, “...culture is created collectively by an organization’s members, whose actions are then guided by the shared culture; and by acting in accordance with the culture, they further legitimize and reinforce it.”

Or as I like to say, if you tolerate it, it’s culture. Put very simply: What behaviors result from budgets, scheduled meetings, meeting agendas, and promotions? And where does improvement fit in this overall picture?

Beware of “sloppy culture thinking”

Important: Culture is not the tailored message transmitted to your customers. It is not a company’s brand, community image, or what some isolated executives delude themselves into thinking it is. Culture is created and recreated every day via transmission from, to, and between the members of your organization and their interactions with your customers. It's actually quite difficult to change an existing culture without a critical mass of people consistently “transmitting” the new culture.

Watson thinks that is it very important to lose what she calls “sloppy culture thinking.” Many blog posts, articles, webinars, and presentations use the word “culture” to give false hope to simple ideas that culture can and should be changed to give an organization a competitive advantage, increase engagement, and decrease turnover.

“But this sloppy thinking about what culture is means that prescriptions based upon that thinking are at best half-baked, and sometimes total nonsense (sorry, but I don’t think that’s an exaggeration),” says Watson. Organizations “need to be much, much better at defining what culture is, what it is not, and to think critically about why, if, and how organizational culture change efforts should be undertaken.”

Watson cites one of the sloppiest assumptions of all (and I agree): “Having a team-building or social event is a great way to change culture.”

I feel that this is a particularly serious trap in most quality improvement education. Thinking about the “increasing participation” example in my January 2013 column, which is the focus for Team 2, I would add: using a social event format to make training and education “fun.”

“Warning: Sending your employees on a team-building social event will not change your culture any more than sending the Amish to a movie will change theirs,” says Watson. “Social events can (theoretically anyway) impact morale and team dynamics, but that is not the same thing as culture! Culture is not so superficial that a couple of events can create any kind of lasting, strategic change.

“And frankly, if your CEO thinks it’s a good idea to spend a bunch of cash on social events [or training] as a strategy to produce the vaguely defined outcome of ‘culture change,’ you have bigger problems than your organizational culture,” Watson adds.

Scenario: How does your culture perceive the role of “quality” (i.e., your role)?

Safety is a particularly hot topic in healthcare these days. There are all kinds of initiatives headed by very hard-working people combing the literature for benchmarks and evidence-based practice. I’m certain many of you are involved in one (or several) of these as the token “quality” representative—usually in the role of the dreaded “data person”—and attend several monthly progress meetings on implementation results.

This is what I’m seeing as an all-too-common scenario: Let’s say you are a new member on a falls-reduction initiative, and the team leader is bringing you up to speed. “Here is the year-over-year graph done by your predecessor at our request for our initiative,” says the team leader, handing you the chart in figure 1.

Figure 1: January—November year over year: 64 (2012) vs. 51 (2011) ↑25%

“We’re up 25 percent from the same period last year, but things should get better soon,” he says. “If you look at the 12-month trend graph [left graph of figure 2], notice that December 2011 through March 2012 were above average. We’ve done a root cause analysis for every fall since then. It worked the first month, but trended up the next three months. So I asked for some money to have a safety fair and give everyone a key chain embossed with ‘Fall’ in Love with Quality.

“The message finally got through,” he continues. “They got zero falls in October, and the CEO was nice enough to buy them pizza. But, darn it, last month, they got nine—the highest number since March! I convinced them to spring big bucks to be part of an IHI falls initiative.

“We’ve got some good benchmarks and best practices. We’re brainstorming some ideas on how to keep the zero in place. Your predecessor was kind enough to help us understand the underlying short-term trends by graphing the three-month rolling average.” (Right graph of figure 2.)

Figure 2: Falls for last 12 months and three-month rolling average

“It looks a little better recently, thanks to the program, but we wanted to see the longer term trend,” continues the team leader. “So, we asked for graphs of the four-quarter rolling average and its trend, which you see below. It was unexpected and disturbing. I hadn’t realized how far we’d crept up. It’s a good thing we started the root cause analyses, but the results aren’t as dramatic as I’d hoped. But with all this attention, it should start coming down soon. I hope December’s result will make that last dot on the trend a little lower to make it look like an outlier.

“We’re getting some great information so far from the IHI initiative,” he continues. “I asked if we could investigate becoming part of Studer’s falls initiative as well, but was told that they’re too expensive.

“Then there was that one very serious fall last month where the hospital almost got sued, so we’re being watched rather closely; going from zero to nine certainly didn’t help.”

Figure 3: Four-quarter rolling average and long-term trend for falls

As the “data person,” how can you help—or do you just passively wait for (or tolerate) their next requested analysis?

Are you feeling overwhelmed? A situation like this is quite a drain on your time and energy. Most important, it’s all for naught. Although there are very hard-working people on this team with a passionate commitment to safety, none of the above (alleged) data analyses are helpful.

How many organizational meetings like this are tolerated? Is there something you would like to do about it?

About The Author

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.