The Smile of the Nurse: Service Quality Improvement

Services make up some 75% of the overall economic activity. But this economic reality is not visible in quality management. Members of quality organizations are mainly from manufacturing, the language we use is production related and our tools are to a large extend directed at solving technical problems.

In this presentation we will point out two distinct reasons why quality is absent in services and what can be done about it. The first one is a historical one and we will show how to address this with better adapted communication. However, even if we do this to perfection we are faced with a fundamental problem: our knowledge has not been developed for the unpredictable world of face to face services.

Using the Cynefin framework as the background and healthcare as an example, we will illustrate the shortcomings of our current methods. We will also indicate what is needed to stay relevant in a services dominated economy.

Why should you Attend:

• Introduction
• In this presentation we will look at how quality management can have an impact on face-to-face quality improvement. Part of it is related to making our current knowledge more attractive to people in services but the biggest problem is that some of our basic beliefs and tools are in contradiction with the essence of front end service situations involving human interactions
• Lost in translation
• Quality management was developed largely in an industrial environment. As a result people in service find little in our Body Of Knowledge that relates to their activities. Examples will be given of typical communication errors
• Humans and Their Interactions
• Standardization, reducing variation and Root Cause Analysis (RCA) are directly linked to quality management. But processes where human interactions play a major part are different. The inputs are people and they cannot be standardized or “set”. Trying to eliminate variation is denying the essence of what humans are: unique individuals. There is no cause - effect relationship or each time the process starts there is a different relationship with different expectations. When we make a pareto, chances are big that we will not find “vital few” but only “trivial many”, except that the many are not trivial to the person who raised it
• The Cynefin framework (Figure 1) is illustrating this limitation of current quality management. The right side of the model represents the predictable world. Problems are simple or complicated and can be solved with classical quality methods
• Inter human relations belong to the unpredictable world. Here we are dealing with complex problems. As quality professionals we want to solve these complex problems from the unpredictable world with tools developed for the predictable world. This is bound to fail
• Apart from the technical skills required I healthcare, human interaction is prominent in the overall experience of a patient in a hospital. The most important element, and the one that can create true delight, is generated in the personnel - patient interaction. A terminally ill patient recently said: "a little patience, a kind word, a listening ear are more valuable to my well-being than the medication that I get"
• So the task for quality professionals is threefold
• Stop dealing with complex problems as if they were simple or complicated
• Start to understand the value and nature of human interaction and accept variability as a positive given when dealing with people. Promote skills like active listening so people are better able to understand what is important for each specific customer
• Create a work environment where human interaction with colleagues and customers is not seen as a loss of efficiency but as a means to create valuable bonds between people that add to a positive experience of employees and customers
• Conclusion
• Quality management has been extremely important and influential in the second half of the 20th century. But if we want to make the 21st century the century of quality we need to change our language to show that quality is valuable for the service economy and we need to accept a different framework to handle complex problems involving human interactions

• A New Approach to Front End Service Quality
• The Complexity of Human Interactions
• The Cynefin Model and the Relation to Current Quality Methods
• Treat People the Way They Want to be Treated
• Expanding the Cynefin Model for Complex Situations
• A New Approach: Observe / Probe / Sense / Respond / Remember
• A Guide to Implementation
• Concluding remarks

• CEO
• Banking
• Tourism
• Healthcare
• Education
• HR Departments
• Quality Managers
• All front end service providers