A change of pace to kick off 2018: a ‘quality fiction’ – telling one story, and revealing another: the fundamental mistakes I see many organisations make that stop them from creating the quality of care and services they want to provide. Our research into ‘what makes an effective quality system’ conducted over 2015-2017, confirmed that the issues highlighted in this ‘quality fiction’ are not only common, but are significant barriers to achieving consistently high quality care within organisations, and may be key reasons for the slow progress we’re making in the human services sectors more broadly. There’s also a few clues on what you can do about it…
Do you recognise anyone? Or any place?
The trouble with vegetables…
There was much happiness in the kingdom of Complia when the Prince announced his engagement to the Princess of Transformania, a kingdom across the sea.
Before he left for the wedding and royal honeymoon tour, the Prince called the Chief Farmer and Chief Quality Controller to his office. The Chief Farmer was a trusted employee and had overseen the thriving orchards of Complia for ten years – so well that the delicious fruit they produced fed the whole Kingdom.
“In six months I will return to Complia with the Princess. One of the things she will miss most about her home in Transformania is her vegetable garden. She has tended it since she was a small girl and loves every plant. It is beautifully laid out and is a very pleasant place to spend a sunny afternoon. The Princess is also an amazing vegetarian cook and likes nothing better than to create delicious dishes full of fresh garden vegetables.
“I’d like you to prepare a vegetable garden for her here. When we return in six months I want to see a beautiful garden filled with magnificent vegetables, ready for our first feast here as husband and wife. The garden must have peas, beans, tomatoes and potatoes, because they are my favourites. I’m not sure which are the Princess’ favourites; just make sure there is a comprehensive range of delicious vegetables for her to choose from. Oh – and this garden must be even more beautiful than hers. The aesthetics must be perfect.”
The Chief Farmer shifted uncomfortably from foot to foot. “Pardon me, Sir, but, as you know, we’ve just opened up a large number of new orchards for export. No-one has any spare time. Are you going to supply new staff to work on the vegetable garden?”
“More staff! Are you kidding! The Royal budget is stretched to the limit as it is, what with my brothers and sisters producing ever increasing numbers of children. And the development of the new orchards has been a very expensive exercise as you know. This is a vegetable garden. How hard can it be?”
“Well, sir, to be honest I’ve never put together a vegetable garden before. I’m an orchard specialist.” The Chief Farmer looked uncharacteristically nervous.
“Really! Well, personally I can’t see the difference. A plant is a plant. I don’t want to hear excuses. I’m sure you’ll figure it out. Don’t we have excellent, committed orchard staff who come to work every day to do a great job?”
“Um, er, yes Sir,…but…”
“So, they should be able to produce a high-quality vegetable garden, shouldn’t they? If they put their mind to it and work a little harder? I’m sure you can organise and delegate the staff to get this done, can’t you?” The Prince’s voice rose. ‘”Or do I need to replace you with a Chief Farmer who can deliver this for me?”
The Chief Farmer loved his job. “No, of course not. I’m right on it.” He bowed and turned to go.
“Oh, and by the way,’ the Prince called after him. “Tomorrow I’ll send you the resources you’ll need to create the garden. There will be mulch and fertilizer and timber and tools, and a fancy ladder and a robot hoe that I bought off late night television. I’m sure they’ll come in very handy. You can buy the seeds when you decide what to plant. And – there’s one more thing. You must use the TQM method of growing: ‘Total Quality Meatless’. The Princess mentioned she had heard about it at a conference and was keen to try it out. Imagine how impressed she’ll be when she arrives here and finds we have used it to build a whole garden from scratch!”
“Ah, Sir…I don’t know what that is…”
“Look it up on You Tube man! Where’s your initiative? Anyway, the Chief Quality Controller will have the job of monitoring your progress and reporting it to me while I’m away, so you can work on it together.”
The Chief Farmer winced. “Of course, Sir,” he muttered with a sinking heart as he passed through the heavily guarded door.
The Chief Quality Controller watched him go. “Sir, I haven’t had much experience with vegetable gardens either…”
“Honestly!” The Prince banged his desk. “What do I pay you all for? If you don’t know, find out. And when you bring me the progress reports, I only want to hear about the excellent progress being made. Unless there’s a disaster of course – but obviously that won’t happen. Are we clear?”
“Now, leave me. It’s time for my wedding suit fitting.”
Soon after, the Prince left for his wedding and royal honeymoon tour. The months passed. The Chief Quality Controller made many visits to the new vegetable garden, and held many meetings with the Chief Farmer. She researched the TQM method, and ran education for the orchard workers who had been selected by the Chief Farmer to fit the vegetable garden into their already full work schedule. She dutifully reported progress to the Prince every month via email, producing pages of colourful graphs and fascinating tables showing planting and growth trends, as well as tracking the rainfall and temperature. In time, there were photos of plump peas, long green beans, ripe red tomatoes and large potatoes. She also included a first-hand story from one of the garden workers in every report, usually discussing how the latest plant disease or bug infestation had been overcome. The Prince was impressed.
“I’m sure the Princess will be so excited when she sees these vegetables that she will forget all about her home garden in Transformania,” he emailed. “And these are beautiful reports. You are doing a fine job, Chief Quality Controller. You are in line for a promotion when I return! With your quality skills and our committed, hardworking garden staff, we have the perfect team.”
The Prince and Princess returned to Complia six months to the day from the Prince’s departure. There was much hustle and bustle to harvest vegetables for the welcome home first feast. Just before sunset the Chief Farmer received word that the Prince and Princess were on their way to inspect the vegetable garden. The Prince arrived leading the Princess, who was blindfolded. He whipped the blindfold off with a flourish as he announced “surprise!”
The Princess looked around, and smiled at the Chief Farmer and Quality Controller. “Surprise what?” she asked.
“Oh, er, this is where I was told to come – perhaps I’ve got the wrong spot. Chief Farmer, where should we look to see the surprise?”
“You are looking at it Sir,” muttered the Chief Farmer, who looked a lot older than he had six months ago. He exchanged a glance with the Chief Quality Officer.
Down the hill from the group was a large field, dug into rows. Some of the rows had been tended with care and were filled with flourishing plants. Some rows were almost empty, except for a lonely group of plants at one end.
Silence. Faces dropped. The Prince turned an unbecoming shade of purple. The Chief Quality Officer and Farmer edged away.
“This looks NOTHING like the Princess’ vegetable garden in Transformania,’ the Prince spluttered. “It’s in a FIELD. It’s not beautiful, it’s not planned, it’s not orderly – and I’m guessing it’s not producing very much – is it?’
“Such beautiful reports full of good news! Month after month! The best garden staff with the best intentions, working hard every day, using the TQM method! Explain to me HOW it is that we do not have a magnificent vegetable garden?”
The Chief Quality Controller’s mouth opened, but nothing came out.
Eventually the Chief Farmer forced himself to speak, finding courage in his desperation. He was going to lose his job anyway. “S-s-sir. If I may. I told you I was no kitchen garden expert. So I did what you said: I researched vegetable gardens based on the TQM method, with the Chief Quality Officer. But I was also running the orchards and getting the new ones going – you’ve put a deadline on those as well, as you know – so I had limited time to run a new project. I fact, I did most of it at night. I delegated different vegetables to different workers, but they also had to do it in their ‘spare’ time. And some of them were more motivated than others…”
The Prince looked baffled. “But the reports. The photos! The stories! And I was told the TQM method was foolproof! What happened???”
Everyone looked at the Chief Quality Controller. She took a deep breath. “Sir, you asked for good news. So I gave it to you. I photographed the best looking plants, and interviewed only the workers who had had a triumph over a problem like an infestation. And to be honest, the TQM method was very confusing. I spent hours trying to work it out and…you know….I don’t think it’s a good fit for our climate and soil. Once we were sure we’d have the vegetables you’d requested, fighting with the Chief Farmer and the garden staff for anything beyond that just got too hard. I’m sorry…I gave up.”
The Chief Farmer broke in. “And I also mostly concentrated on the peas, beans, tomatoes and potatoes. Their quality was good but I didn’t know how much of each we were expected to produce. I was guessing. It looks like we’ll just have enough of them for the first feast though,” he added brightly.
“What about the aesthetics of the garden?” enquired the Princess, as the Prince appeared incapable of speech.
“We didn’t really know what you meant by ‘aesthetics’,” the Chief Quality Control Officer muttered, cheeks blazing. “There are so many different ways you can lay out a vegetable garden…we just weren’t sure where to start.”
“Didn’t I supply all the materials and resources you needed?” the Prince spluttered.
“Yes – well – you supplied some resources,” said the Chief Farmer. Some were useful and some not. That robot hoe couldn’t dig a straight line if its life depended on it. We never got around to using the ladder. You see, we didn’t really know what you wanted. So I did what we thought was right, and what was easiest and quickest, which was finding a fallow field and allocating each worker a row for their vegetables.”
“So….you didn’t even try to design a beautiful garden with decorative motifs and raised beds and sharp edges and comfortable seats?” The Prince could barely get the words out. “No, don’t answer that. And, I imagine we won’t be seeing a comprehensive array of vegetables at the first feast, either. Do we have anything beyond peas, beans, tomatoes and potatoes?”
The Chief Farmer stepped forward and picked up a basket. He removed the covering cloth, revealing a motley mix of vegetables. “Sir, many of the ‘extra’ vegetables didn’t grow. We just didn’t have the time to work them properly. But we do have some for the first feast. Here’s the samphire, Brussels sprouts and parsnips that didn’t do too badly.”
At this the Prince put his head in his hands. “Brussels sprouts! Parsnips! I hate them! And what on earth is samphire?”
“Well…we heard it was hardy…”
The Prince held up his hand with a sigh. There was another silence while everyone gazed from forlorn basket to forlorn field. The Princess asked sadly, “Spinach? Cauliflower? Carrots? No?” She turned to the Prince. ‘Remember I promised I’d make you my world famous spinach, cauliflower and carrot pie as soon as we settled in? Well you can kiss that goodbye…you know, if you’d involved me I could have helped! As nice as surprises are, something as important as growing quality vegetables requires more than guessing and hoping. And it works a lot better when you can draw on real experience and knowledge. I could have told you exactly what we needed, and helped make it happen.”
The Prince groaned and turned his gaze on the Chief Quality Controller. “You’ve always been so good with the quality of the orchards: researching the best methods and developing useful tools. What happened?”
“Sir, we – we…didn’t know enough. We didn’t have a picture in our heads of what you wanted the finished product to look like and produce. We didn’t have a blueprint or a plan. With the orchards, we know exactly what the expectations are and what we’re trying to achieve. Without all that, we had to guess, as the Princess said, and use the resources we had, which were a bit random and not really what we needed…and this is what we got.
The other problem was…well, I have to be honest here…I don’t have any line authority over the Chief Farmer. I’m not his manager. I could make suggestions, but he wasn’t interested in my input. We ended up arguing about what was important and how to do things. It wasn’t like the orchards where we’re both engaged in working together to make the orchards the best they can be – because they benefit everyone. This project was really about… well…you, and no-one was excited about it. So we focused on the peas, beans, tomatoes and potatoes, because they were mandatory. Anything else was an extra, including the aesthetics, and in the end…didn’t get done very well – or at all…’ her voice trailed off.
The Prince took a deep breath and the Chief Farmer and Quality Controller braced for impact. But the Princess spoke first. “So – we ended up some of the things the Prince wanted, but not what we all needed.”
The Chief Quality Controller decided to throw herself on the Princess’ mercy. As she was opening her mouth to plead for her job, a surprising thing happened. The Princess winked.
“It seems the Prince assumed that you both knew what was important, and gave you instructions and tools that were less than helpful.” She glanced at the glowering Prince. “Might as well be brutal here, my dear, or we won’t learn anything. And you can be a bit vague with your instructions, and overly optimistic about how well people read your mind and have your best interests at heart. Everyone tried their best, but of course they focused on what was mandatory – and what else they could get done with the time, resources and knowledge they had. And, my dear, may I say that designing and growing a successful and beautiful vegetable garden is – like most things – a lot harder than it looks and takes constant oversight, which I’ve never felt you quite appreciated…” The Prince grimaced. “If you’re going to run a successful kingdom, it will be helpful if you could be a bit more specific and helpful. Even great staff are not mind readers – or superhuman,” she finished softly.
The Prince was silent for a long minute. Then – amazingly – he smiled at the Princess and turned to the Chief Farmer and Quality Controller.
“The Princess is right! – as always. Well, here’s my shot at honesty: I did not give this the time or attention it deserved. I didn’t work with you to develop the vision or the concrete outcome I wanted, nor did I bother to find out what the Princess wanted. I didn’t supply resources designed to achieve that outcome; in fact, I burdened you with tools and methods that looked good but didn’t help because, well, I thought it would impress the Princess. I didn’t make sure you had the skills and information you needed, nor ask enough serious questions about progress. I didn’t want the brutal facts about where things weren’t going well, or where the gaps were. Basically – I set you up to fail. I’m sorry.”
The Quality Controller and Chief Farmer leaned on each other, weak with relief – and admiration for their fabulous new Princess.
“OK,” said the Prince, taking the Princess by the hand. “Let’s start again. This time, the Princess will lead the project as I can tell she’s itching to get her hands on it.” He began to lead the Princess away, then stopped.
“And in six months, we’ll hold a second ‘first feast’, celebrating the Complia vegetable garden version 2.0. First, we’ll get clear about the food we want to serve and what we can produce in this climate. Then we’ll develop a shared vision, find the production model that best fits our situation, develop the plan for making it happen and supply the right tools, skills and people for the job. We might even instigate a vegetable sharing scheme with those who work on the garden, for a little added motivation. I can’t promise you’ll get all the resources you’ll need all at once, but you’ll get what you need to start off properly and I’ll commit to resourcing it as you progress.
“Speaking of progress,” he glanced at the Chief Quality Controller, who gulped – “this time I want the real story, so we will work together on how best to present it. Fewer selective photos and more facts, perhaps? Stories that cover both the successes and failures, so the Princess and I can do what it takes to guide the garden to success?
“And Chief Farmer? Here’s my first clear instruction for version 2.0: no parsnips or Brussels sprouts. I’ll reserve my decision about the samphire until I’ve tried it.”
And with a regal wave, he was gone.
If you enjoyed this ‘quality fiction’ as another way to explore quality issues, stay tuned for my new book coming out later this year – where a CEO has six months to take a health service from slump to success…
Five ‘trouble with vegetables’ points to ponder for creating great care in 2018
1. Do you know exactly what you want and need from your ‘great care’ garden in 2018? What it should look like and produce? Have you worked with those providing and receiving the care to design it?
2. Do your board and executive fall into the trap of assuming that everyone understands what great care looks like, how to make it happen – and wants to make it happen?
3. Is your quality system focused primarily on nailing mandatory requirements, with a range of other random initiatives added that you hope will add up to great care?
4. Do your point of care staff and managers think your quality system gets in the way of creating greatness at point of care instead of supporting and driving great care? Is it based on a theory or model that isn’t fit for purpose?
5. Do the leaders in your organisation not quite appreciate the challenge of creating consistently high quality care, and therefore don’t give this the attention and support it requires?
QUALITY BITES QUOTE OF THE MONTH:
‘Without focusing and getting to clarity, you cannot lead. You cannot motivate. You cannot plan. You cannot communicate.’ (Bobb Biehl)
Build your quality intelligence
‘Quality Literacy’: ‘Knowledge of the components of an effective quality and safety system that support consistently safe, high quality care in complex organisations; and the will and skill to apply that knowledge to provide safe, high quality care for every consumer.’ (Balding, 2016)
My favourite creating great care in complex systems resources are listed on my website. All excellent Quality Intelligence Improvers! Find them here.