One of the words that causes the most debate and confusion in the world of Improvement is the word standard – because it has so many different yet inter-related meanings. It is an ambiguous word and a multi-facetted concept.
For example standard method can be the normal way of doing something (as in a standard operating procedure or SOP); standard can be the expected outcome of doing something; standard can mean the minimum acceptable quality of the output (as in a safety standard); standard can mean an aspirational performance target; standard can mean an absolute reference or yardstick (as in the standard kilogram); standard can mean average; and so on. It is an ambiguous word.
So it is no surprise that we get confused. And when we are confused we get scared and we try to relieve our fear by asking questions which doesn’t help because we don’t get clear answers so we start to discuss, and debate and argue and all this takes effort, time and inevitably money. But the fog of confusion does not lift. If anything it gets denser. And the reason? Standard Ambiguity.
One cause of this is the perennial confusion between purpose and process. Purpose is the Why. Process is the How. The concept of standard applied to the Purpose will include the outcomes: the minimum acceptable (safety standard), the expected (the specification standard) and the actual (the de facto standard). The concept of standard applied to the process would include the standard operating procedures and the reference standards for accurate process measurement (e.g. a gold standard).
To illustrate the problems that result from confusing purpose standards with process standards we need look no further than education. What is the purpose of a school? To deliver pupils who have achieved their highest educational potential perhaps. What is the purpose of an exam board? To have a common educational reference standard and to have a reliable method for comparing individual pupils against that reference standard perhaps. So where does the idea of “Being the school that achieved the highest percentage of top grades?” fit with these two purpose standards? Where does the league table concept fit? It is hard to see immediately. But we do want to improve the educational capability of our population because that is a national and global asset in an increasingly complex, rapidly changing, high technology world. So a league table will drive up the quality of education surely? But it doesn’t seem to be turning out that way. So what is getting in the way?
What is getting in the way is how we confuse collaboration and competition. It seems to be that many believe we have either collaboration or competition. Either-Or thinking is a trap for the unwary and whenever these words are uttered a small alarm bell should ring. Are collaboration and competition mutually exclusive? Or are we just making this assumption to simplify the problem? We do that a lot.
Suppose the exam boards were both competing and collaborating with each other. Suppose they collaborated to set and to maintain a stable and trusted reference standard; and suppose that they competed to provide the highest quality service to the schools – in terms of setting and marking exams. What would happen? An exam board that stepped out of line in terms of the standard would lose its authority to set and mark exams – it would cut its own commercial throat. And the quality of the examination process would go up because those who invest in that will attract more of the market. What about the schools – what if they collaborated and competed too. What if they collaborated to set and maintain a stable and trusted reference standard of conduct and competency of their teachers – and what if they competed to improve the quality of their educational process. They would attract the most pupils. What could happen if we combine competition and collaboration so the sum becomes greater than the parts?
A similar situation exists in healthcare. Some hospitals are talking about competing to be the safest hospitals and collaborating to improve quality. It sounds plausible but it is rational?
Safety is an absolute standard – it is the common minimum acceptable quality. No hospital should fail on safety so this is not a suitable subject for competition. All hospitals should collaborate to set and to maintain safety – helping each other by sharing data, information, knowledge, and understanding. And with that Foundation of Trust they can then compete on quality – using the competitive spirit to pull them every higher. Better quality of service, better quality of delivery and better quality of performance – including financial. Win-win-win. So when the quality of everyone improves through competitive upwards pull then the level of minimum acceptable quality increases – so the Safety Standard improves too.
A win-win-win outcome is the purpose of the application of the process of Improvement Science.