What could WOL for Healthcare look like?

Her note started off nicely enough. Then I read her feedback, including a challenge I didn’t know what to do with.

Bettina had heard about WOL Circles at a conference and liked the idea. “I started my first Circle directly. With great success!” She said she is working as a Change Manager in a large non-profit healthcare organization in Germany, and that she wanted to spread Circles. But she made it clear that WOL, in its current form, would never work. 

“The nurses, doctors, and other professionals do not have 60 minutes a week for WOL, there is too much text, the examples have to refer to the health sector…” 

Ouch. She even said the German translation wasn’t acceptable, as the informal pronoun (“du”) simply isn’t used in her organization’s “official papers.”

I knew she was right. I asked if we could speak on the phone. 

The challenges in Healthcare

Healthcare organizations suffer from the same cultural issues that plague many large companies. The hierarchical structures limit information flows in ways that are bad for individuals, the organization, and the patient. Too often, nurses don’t question doctors and medical technicians don’t question the ambulance manager. (Atul Gawande, surgeon, author, and CEO of the recently-formed healthcare venture formed by Amazon, Berkshire Hathaway, and JP Morgan Chase, captured these challenges in dramatic fashion in The Checklist Manifesto.) 

The same is true across the hierarchy as well. People in a given role are not in the habit of of sharing problems and solutions to improve quality, and in many cases there may be no mechanism to do so. So the same mistakes get repeated, and innovations don’t spread. 

On top of such challenges, all of this takes place in an environment that is extraordinarily demanding. It’s busy, stressful, and unpredictable - and the stakes are extremely high.

One possibility

Of course, not all healthcare organizations have the same cultural issues. Buurtzorg, for example, has over 10,000 professionals in “a nurse-led model of holistic care” that emphasizes “humanity over bureaucracy.” They are portrayed in Reinventing Organizations as a model of self-organization and self-management. But for every Buurtzorg, there are thousands of traditional companies. 

How could WOL help?

I told Bettina how we had already adapted WOL for leaders by making it shorter and simpler, and by integrating it into a reverse mentoring program. Perhaps we could do something similar. 

Together, we decided that Bettina’s colleagues could also meet in pairs (perhaps one with more experience and one new to the organization), and we could limit meeting to no more than 30 minutes. Then we identified eight different exercises over eight weeks - eight contributions they could make that would help them find their voice, improve their craft of patient care, and enable them to re-connect with the sense of purpose that inspired them to join the profession in the first place.

What would you do?

The challenges faced by people in healthcare environment are similar to those in other operational environments, be it manufacturing, retail, transportation.

As different as those jobs may be, the people doing them all share the same human needs for control, competence, and connection. And all of the organizations they work in need to improve quality for their customers and for their own sustainability. The future of work isn’t limited to people working in offices.

Bettina and I will meet in Frankfurt this week to work on details of a pilot. Whatever the outcome, we’ll surely learn something that can help us take a next step and try again.

If you were Bettina, what would you do? What could WOL for Healthcare look like?

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The life & death of Quality Circles (and a more modern way to implement them)

By the time I first heard of a Quality Circle, the idea was already almost 30 years old. It’s “a group of workers who do the same or similar work, who meet regularly to identify, analyze and solve work-related problems.” I was in my twenties at the time, doing research for my first book, and I believed these Circles could make a huge difference.

The method was introduced in the 1960s by Professor Kaoru Ishikawa. By the late 1970s, more than 10 million Japanese workers were in Circles. More recently, China is reported to have formed over 20 million Circles in a a range of industries.

But in the US, at least, “quality circles are almost universally consigned to the dustbin of management techniques.”

Why? What can we do to make a good idea even better?

Out of the Crisis

Dr. W. Edwards Deming, a pioneer of the quality management movement, was one of my early heroes when it came to work. His management philosophy wasn’t just for managers, but for everyone. Remarkably, his 14 principles put people at the center of quality and statistical process control.

“8. Drive out fear. 
12. Remove barriers that rob people of pride of workmanship.
13. Institute a vigorous program of education and self-improvement for everyone.
14. Put everybody in the company to work to accomplish the transformation. The transformation is everybody’s job.”

When Out of the Crisis was published, Deming was already in his 80s. He referenced Quality Control Circles (or QC-Circles) several times. Though he was familiar with their success in Japan, he had also seen failed implementations in the US, and he was not optimistic about their success there.

“The idea has appeal. The production worker can tell us a lot about what is wrong and how improvements can be made: why not tap into the source of information and help?
[But] a QC-Circle can thrive only if the management will take action on the recommendations of the Circle. Many QC-Circles are, I fear, management’s hope for a lazy way out.”

Do you treat them as human beings? Or not?

Something went wrong. QC Circles were designed to be a way for people to actively take pride in their work by having a voice in making it better. But Circles often became a management tool focused on cutting costs (and jobs), and on finding fault. 

In his book, Deming excerpted a speech from Dr. Akira Ishikawa (who became president of Texas Instruments in Japan) about why Circles worked in Japan but not in the US.

“In the U.S., a QC-Circle is normally organized as a formal staff organization, wheres a QC-Circle in Japan is an informal group of workers. A manager in Japan serves as an advisor or consultant. In the U.S., a manager of production, to get rid of the job, appoints facilitators for Quality of Work Life, Employee Involvement, Employee Participation, QC-Circles, all of which disintegrate. 
The second contrast is the selection of the theme for a meeting and the way in which the meeting is guided. In the U.S., the selection of a theme or project and how to proceed on it are proposed by a manager. In contrast, in Japan, the things are decided by the initiative of the member-workers.
The third feature is the difference in hours for a meeting. A meeting in the U.S. is held within working hours. A meeting in Japan may be held during working hours, during the lunch period, or after working hours.
In the U.S., monetary reward for a suggestion goes to the individual. In Japan, the benefit is distributed to all employees. Recognition of group achievement supersedes monetary benefit to the individual.”

These aren’t just procedural or technical differences. They’re fundamental. The way that Circles are implemented can determine whether or not employees tap into their innate needs for control, competence, and connection. 

“One Japanese plant manager who turned an unproductive U.S. factory into a profitable venture in less than three months told me: ‘It is simple. You treat American workers as human beings with ordinary needs and values. They react like human beings.’
Once the superficial, adversarial relationship between managers and workers is eliminated, they are more likely to pull together during difficult times and to defend their common interest in the firm’s health. Without a cultural revolution in management, quality control circles will not produce the desired effects in America.”

“WOL for Quality”

When Deming observed Quality Circles, it was well before enterprise social networks, before 4 billion people were using the Internet, before modern research on why people do what they do. Today, it’s easier than ever for employees in any environment to make their ideas visible, to tap into what others in the company know, and to connect and collaborate with them. 

One experiment I plan to work on is to apply the basic elements of WOL Circles - a voluntary, self-organized, safe and confidential space using structured guides - to making work better in a wider range of environments. Call it “WOL for Manufacturing” or “WOL for Hospitals” or even “WOL in the Classroom.”

To suit each specific kind of environment, I would adapt the guides to include different ways for Circles to form and interact, different contributions to make, and different technologies for making them. If a company is already spreading WOL Circles, then such an experiment would be a natural extension, a way to include people in non-office environments.

Perhaps, instead of waiting for “the cultural revolution in management” that Deming thought was necessary, we can take action now. Perhaps we finally have the tools and practices we need to create grassroots movements that matter, that can show management what’s possible and inspire them to enable broader institutional changes.

The missing piece in most quality programs

I fell in love with W. Edwards Deming over twenty-five years ago. He was already in his 90s by then, but his philosophy of work and management was only gradually spreading. I felt like I had discovered A Fundamental Truth. But like other Truths, it was inconvenient to people in power, and was ignored or purposefully misinterpreted.

So when I saw a recent article titled “Deming, Finally!” I was curious. When I noticed it was co-authored by Celine Schillinger, I made a point to read it carefully, since I greatly respect her work driving change at the pharmaceutical company, Sanofi.

“Today, everyone in the manufacturing quality world has read, heard, spoken about Deming. His vision for quality and “14 points of management” as well as the “System of Profound Knowledge” in particular are inescapable reference points.
However, Pharma may have got this all wrong for the last 30 years. By focusing on processes, control and exhortations, manufacturers have missed the essence of Deming’s message.
Deming advised us to actually put the Human at the center of quality and to focus on how the system works.”

The missing piece in most quality programs is the human being. Deming understood that and most of the elements of “the Future of Work” decades ago, but he wasn’t really heard.

Deming would have benefited from better communications & behavior change methods, and I think Working Out Loud Circles can help with both - whether it’s work in an office or in manufacturing plants, in hospitals or schools. I’ll offer some specific suggestions in an upcoming post. In the meantime, read Celine’s article if you can, and let me know what you think about the topic. 

How would you make quality and continuous improvement more human?