I'm working on a change management course for a friend of mine right now and in doing so, of course Dr. W. Edwards Deming's research on quality improvement always comes to the surface. I know that Total Quality Management is considered so passe among the elite consulting set, but like an old and comfortable pair of shoes, I go back to it regularly. If anything, I think most of the things we are trying to do these days still go back to Deming's interpretation of Shewart's work, and we just keep improving on it each time (which is exactly as I think he would have wanted it). I also took the time to take a bike ride with my friend and colleague, Chief Ed, to get away from the computer for a little while, so as it works, one thing crosses with another to provide some inspiration for the ol' blog.
We were talking about improvement on the process and issues that we, as well as many others, experience daily in their organizations. We actually got to talking about a few of the initiatives we are moving forward with and the continued issues of getting from Point A to Point B, realizing there is a little bit of travel that has to be endured between those two points. You don't just "get there" and as any parent who has driven with children can appreciate, our subordinates, peers, and bosses all want to know "are we there yet?"
Dr. Deming discussed regularly the need for organizations to optimize their processes and "refine", or make small adjustments to improve, all the while turning the organization into a finely tuned machine. Unfortunately, when we are creating change, we have this idea that as things turn and we start to see the fruits of our labor, we begin to believe we have accomplished our task. In fact, we have really just begun; we have to then look at what we have, start at the end, and work our way back up through the process to tighten it up. Here, really, is the moment is where change really begins to create friction.
To truly optimize your organization, the leadership must educate the players on what the process is and what part they each play in it, so they can begin to understand how every part inter-relates to the bigger picture. I have used the analogy of the football team before: only eleven people working together in harmony can create success. You can have the best quarterback, the best linemen, the best receivers, the best backs – but if one part lets down the other, disaster is likely to ensue. In healthcare, you can have the best surgical team, the best nursing staff, the best of everything, but if we can't work together, we find the patient suffers.
Cooperation must be established between all the components and the breaking down of barriers (Dr. Deming's Ninth Point) is very important. By knowing what WE contribute to the end process, and by being the experts at THAT part of the big picture, WE can create positive change by analysis of what we do and tweaking it to develop an even better result. We can get feedback from those who "give us our supply and materiel" and from those we "deliver our part to" which permit us to better understand the process. But the reason this is the part that breaks down is like I have said before, because no single raindrop wants to believe it is the cause of the flood.
We look at our own contribution to the project as something we have literally given birth to, and we are reluctant sometimes to say that either our part needs adjusting, or our approach needs refining, or maybe even that our contribution is irrelevant and should be removed from the process (THAT is a hard one to deal with). It is important, though, that if we truly believe in what we are doing and whether we want to provide what is best for the customer or not, if our contribution is problematic, we must adjust. And that goes straight to the suppression of ego for the good of all.
There are changes going on in both the fire and the EMS sides of the business right now in which we have to really consider that what we are doing now may be entirely irrelevant soon. We must begin to ask the hard question as to what it is we do and how we plan to adjust for the changes in the future. These are not easy questions, but we can ask them, or someone will be asking them in our absence. If we want a say in the process, I'd suggest we initiate the dialogue rather than stick our heads in the sand and pretend that it isn't going to happen. These are changes that really go straight to the heart of what we believe today to be the best way of doing things, that tomorrow may be exposed as not helpful.
If your department isn't having conversations like these right now, I can reassure you, there are others that are. While some of you are disagreeing as to whether or not fire apparatus should be red or some other color, there are those who are considering "How could we do the job without fire apparatus?" You can call me crazy all you like, but trust me, there will be a time in your future where you will be saying, "Maybe he had something there."
The Swiss watchmakers (while many of you have heard the story, you'd be surprised at who has not) were considered to be the most exacting and amazing craftsmen of their time. Their product, the Swiss watch, had the reputation as a highly accurate, amazing piece of artwork and they were highly prized by customers who owned them. The impact of the quartz movement watch, ironically, developed by the Swiss, forced the Swiss watch workforce to their knees, dropping the number of workers in this industry from 65,000 to 10,000 in just ten years. We can choose to understand the changing expectations of our constituents, or we can ignore them at our own peril.
Spend some time looking at what it is we do and ask; "Is there a better way?" And be honest with yourself, because the time will come that if you don't, someone else will. I'm betting you'd rather be on the side creating change than on the side having change forced down your throat.