This is the second article in a series about Clinical Service Quality Management in Health Call Centers.

Most organizations mention quality as an important part of clinical service delivery. The depth of this commitment ranges from “we strive to do better…” to “quality is imbedded in our processes and management philosophy.”  Few organizations understand the science of quality and how an organization’s immune system undermines quality:  “Our people are wonderful and anyone who says different …”

Organizations, departments, and workgroups first react to quality measurement by closing ranks and resisting scrutiny. This is normal. A group’s instinct is self-preservation. This is especially true of clinical teams who have historically been under siege. The challenge is to separate the problem from the people. A good place to start is with Edwards Deming.

Deming believed people fail because:

•    The process is designed for failure
•    The training process fails to train
•    The recruitment fails to match people with work

Usually all three work in concert to create havoc. However, rarely, do you have someone come to work and say, “Gee, how can I fail today?” or “What can I intentionally do to destroy my credibility?”  Most people want to do meaningful work successfully.  So, when “Wonderful” people are put into no-win situations driven by poor process design, training, and skills, they are no less wonderful; however, they may do less than wonderfully. Breaking down self-preservation barriers requires involving everyone in the solution. This begins with explaining what drives success and failure, then asking team members: “At the end of the day, how do you know you have been successful?”  And, “What are the barriers to your success?”

Do not be surprised if few people cannot answer the first question but unload a torrent on the second. This is the first step in externalizing the problem: get a read on everyone’s standard of good and bad. Next, work to identify and measure ways to overcome these barriers as a team.

A word of caution: Be careful what you ask for. Once a team opens up, the infrastructure must be capable of acting on the concerns. Re-engineering for quality requires, among other things, a mandate from the top, and most importantly, a capacity to evolve – resources, software, and knowledge.