As I’m sure most of you have discovered, transformation is not a linear, predictable process. People have insights and breakthroughs in fits and starts, and growth is full of individual, inner personal transformational phenomena. This process can be seriously compromised by traditional attempts to measure them, which are based in pedagogy theory. But did you know that predicting your behavior is as simple as A-B-C?

“A” is an activating event that you experience.
“B” is the belief(s) that you have about that event, filtering it through your unique personal belief system, which results in:
“C” your (observable) consequential behavior(s).

The activating event is a trigger for one’s belief system—ingrained, unconscious rules that result from one’s unique processing of the first 20 years of life experiences. The event is filtered through this system, resulting in an automatic, conditioned, immediate behavior. This behavior could be described objectively and nonthreateningly—as could the consequences it ultimately created in the given situation.

The flow of things, like the alphabet, is: A filters through B, which leads to C.

Any improvement effort ultimately faces the issue of standardizing processes, in many cases under the intense pressure of an impending certification audit. Ask yourself: Is your rationale for standardization merely to pass the audit, or is it a serious effort to improve quality? If it’s the former, I’m positive most of you are clever enough to put up a good front in that tiring cat-and-mouse game, and you probably thought part one of this article was too much work. If it’s the latter, then I’d like to suggest a few additional nuggets of wisdom as you work through the plan-do-check-act (PDCA) cycle as it applies to standardizing processes.

Any article about control charts leads to inevitable (and torturous) discussions of special cause tests—all nine of them. No wonder confused people continue to use things like trend lines. But I’m getting ahead of myself.

After reading Joe De Feo’s July 8, 2011, Quality Digest Daily article, “A Positive Prognosis: Transforming Health Care in America,” I took another look at the wonderful book, Escape Fire (Jossey-Bass, 2003), a compendium of Dr. Donald Berwick’s inspiring plenary speeches at the Institute for Healthcare Improvement’s (IHI) 1992–2002 annual forum. Berwick is probably the leading health care-improvement thinker in the world. He is the former CEO of IHI and, as some of you know, a controversial Obama appointee as head of the Centers for Medicare and Medicaid Administration. In my opinion, he is most definitely the person for the job. As if it wasn’t difficult enough to deal only with health care cultures, he now has the thankless job of integrating messy political agendas into the very serious business of health improvement.