A Culture of Quality: What It Is and What to Break to Get It

By Don Jarrell

Is there a healthcare organization anywhere that doesn’t want to provide top quality care? This is one of the highest priorities among healthcare professionals and hospital managers. It also may seem like an unachievable dream for many. Between staffing limitations, regulatory requirements and inter-department difficulties, many organizations don’t see a clear path to achieving their quality goals.

Providing top quality care and operating/performing efficiently require a certain way of working throughout the organization—a culture of quality. Embedding a culture of quality is a transformative undertaking and often requires big changes to achieve. Said more bluntly, it means breaking a lot of things.

What is a culture of quality? There are five fundamental components.

  1. An overall perception of quality. This is a subjective view, an opinion, held by staff and management that is rooted in day-to-day experience. It is influenced greatly by the other four components.
  2. A learning organization. A hospital with a culture of quality is committed to continuous improvement. While errors in patient care are certainly not encouraged, staff members do not play the “blame game” when a mistake does get made. Instead, the organization takes the opportunity to learn from mistakes in order to improve.
  3. Open, transparent and bi-directional communication. Because a culture of quality is non-punitive, there is no reason to avoid reporting events. There is no such thing as an event that is too insignificant to report—this includes capturing “near misses,” which will contribute to a more complete picture of care status. With this kind of comprehensive information gathering, the organization has a much more complete basis for learning and performance improvement. When errors do get made, feedback is constructive. No one, including management as well as staff, feels that they need to hide information from others or share only with a few individuals or departments. This fosters more robust two-way communication between the organization’s management and the “in the trenches” professionals, which will naturally increase focus on quality.
  4. Teamwork. A culture of quality is inclusive, both within units and across units. Functional and informational siloes do not exist, and when the need arises individual will cross functional lines to help.
  5. Management advocacy. A culture of quality exists from the top down. Management from the highest level in the organization and into all operational units are active advocates of the culture. Apologies for the cliché, but they walk the walk and talk the talk—and the commitment to quality moves from a statement on a wall plaque to a statement made by the daily actions of every member of the organization.

How are you doing so far? Does your organization have a check against each one of these components? If not, how can you get there?

To figure out how to create a culture of quality in an organization that lacks one, it is useful to decide what needs breaking. Often, an organization that does not have a culture of quality has the opposite characteristics to those listed above. For example:

  • Units are in informational and functional siloes, so there is a “this is not my problem” attitude when crises arise or help is needed elsewhere in the organization.
  • Information is hoarded rather than shared, both within and across units.
  • Management may talk the talk of quality, but they don’t follow through in day-to-day activities and therefore don’t demonstrate any commitment to it.
  • Event go unreported, and the same mistakes keep reoccurring.

A useful way to find what needs breaking is to take the list of characteristics above and turn it on its head. In other words:

  1. When management are clear and active advocates of quality, teamwork is fostered.
  2. When teamwork increases within and across units, there is more open and transparent communication.
  3. When there is more open communication, learning and continuous improvement is enhanced.
  4. And when this string is in place, there is a clear overall perception of a commitment to quality.

This prompts questions like:

  • How can management clearly demonstrate its commitment to quality on a daily basis? The answer might be as simple as the old “management by walking around” strategy—get management out of their office suites and into the units, asking questions and observing activity.
  • What will motivate staff to play well with others? Take away the blame game, make it safe for questions to be asked and mistakes to be identified. Foster cooperation by eliminating reasons for hoarding information and resources.
  • How can information be made more readily accessible to everyone? Find ways that information can be accessed by anyone, any time, without having to run the gauntlet of authority.
  • What will switch us into learning mode? Make that readily accessible information easy to analyze and set up ways to gain deeper insights from it, then act on those insights in order to make improvements.

Figuring out what needs breaking to transform to a culture of quality depends on your own particular environment, but there is one often-overlooked catalyst that will support transformation in any organization. Software that includes the five fundamental components of a culture of quality in its design is invaluable because it promotes a culture change simply through daily use. In other words, incorporate the right software into the right places, and you will see the right changes occur naturally—and sustainably.





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