John W. Moran, PhD is a Senior Quality Advisor to the Public Health Foundation (PHF), a Senior Fellow at the University of Minnesota, School of Public Health in the Division of Health Policy and Management, and faculty member of the CDC/IHI Antibiotic Stewardship project 2011-2012. He also serves as an Advisory Board member of Choose To Be Healthy Coalition for York County, Maine (2011-present). He is a member of PHAB’s Evaluation and Quality Improvement Committee, and djunct Professor in the Arizona State University College of Health Solutions' School for the Science of Health.
Sonja Armbruster is an expert consultant to PHF, and works for Wichita State University’s Center for Community support and research to coordinate a new initiative aimed at strengthening the public health system in Kansas. Previously, she worked at the Sedgwick County Health Department—one of the first to be accredited—where she served in a number of administrative roles, including health promotion program management, development of the strategic plan and performance management system, supervision of the quality improvement (QI) and accreditation preparation efforts, and leadership of MAPP (community health assessment and improvement planning). She occasionally serves as adjunct faculty for both the University of Kansas Master of Public Health program and the Wichita State University College of Health professions.
“The only thing of real importance that leaders do is to create and manage culture….If you do not manage culture, it manages you, and you may not even be aware of the extent to which this is happening.” - Edgar Schein, Professor, MIT Sloan School of Management*
A culture of QI can be defined and assessed using these six dimensions which can be assessed on a Likert scale and illustrated on a radar chart:
- Commitment—Senior management demonstrates commitment to QI by providing training and expectations for staff participation in QI projects
- Capability—Staff are trained to use QI tools and data management skills needed for QI
- Understanding of Customer Expectations—Strategies exist to collect, analyze, share, and act on customer feedback
- Process Focus—All activities have clear performance criteria
- Institutionalization—Use of QI tools and strategies are the organizational norm
- Empowerment—Employees closest to the issue feel accountable to make change themselves or be part of a team empowered to make a change
Conducting an organizational assessment of the culture of quality in your organization can reveal opportunities for intervention and improvement.
The question to answer is “do you foster a relentless passion for customer satisfaction every day?” A good example to follow was developed by Zingerman’s Delicatessen in Ann Arbor. The co-founder of Zingerman's has written a book called Zingerman’s Guide to Giving Great Service outlining five simple steps:
- We teach it
- We define it
- We live it
- We measure it
- We reward it
Clearly this organization is so deeply committed to customer service, that they have written a book on institutionalization of cultural expectations, including adopting language like: “Great food is the lock and great service is the key,” and “Customer satisfaction is the fuel that stokes Zingerman’s fire.” What is your stated vision and key for customer satisfaction?
Keeping a constant focus on meeting—and better yet exceeding—the needs of your customers, or the people your organization serves, requires an organizational culture that demonstrates a commitment to quality improvement.
Once you establish a culture of quality improvement the hard part starts: keeing the culture focused on continuous improvement. In order to sustain a culture of quality improvement, you will need to constantly manage behavior to sustain improvement. This is “anchoring the change” which an important next step in which you must keep monitoring progress and be ready to react if the anchor starts to drift. This managing behavior and anchoring is not something you can neglect since culture is a wily foe and will quickly revert back to the old status quo.
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