What’s Your Role in Hospital Quality?


I snapped this pic while visiting a hospital earlier this year. This was out in the cafeteria as part of a series of signs that featured real people talking about their real role in quality.

This is great, not just the sign, but having that conversation with your employees.

Is somebody “just a housekeeper” or do they play a critical role in infection control?

Do you “just deliver meals” or do you provide a level of service and caring that helps with somebody's healing? Are you racing around to give meds on time or also creating an environment of “loving care?”

Are you breaking rocks or building a cathedral?

Are leaders forcing compliance to standardized work documents or building a culture of purpose and intrinsic motivation? Are we often lost in the details at the expense of the big picture issues?

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. I work almost exclusively with the professional regulated staff at the hospital. Pretty much everyone has the Q part of QI down. Professional staff all seem to recognize that their is a standard they need to work at. But I recognize that the above example is that of people setting their sights above the standard, towards an ideal, and not just settling to meet a minimum standard. I have frequently warned managers when they set minimum standards, not because I believe that in doing so will result in staff being only willing to work to the standard and no more,… but because I concerned about what effect such a minimum standard message will have on the culture of the group or organization.

    Having done far too much policy and procedure work in the past, I readily agree with someone that stated that the thickness of an organizations policy and procedure manual is directly proportional to the dysfunctional culture that is present in the organization.

    From my perspective in my current role, where the difficulty occurs is with the “I” part – improvement. Not many can answer what they are currently working on to improve service or outcomes. We have really shifted away from having any focus on continuous improvement. Part of the reason being there has been significant changes in the organization and leadership and almost everyone has retrenched to practices that they feel are safe. And in many cases the improvements that do occur almost seem accidental… (although I would attribute them to small pocket of an improvement culture that occasionally pop up to address a specific issue).

  2. I think that poster is a beautiful example of how to do a poster. There are no admonitions, no exhortations, just a real example of how someone is appropriately (and expertly, I might add) applying “respect for people” in pursuit of continuous improvement. It’s inspiring and oddly relevant and meaningful to me, and I don’t even work in a hospital. It is a perfect example of the better point of view, as you said, “building a cathedral” as opposed to “laying bricks”. I think even Dr. Deming would approve.

    • Yes, the poster is artfully done. A powerful message without hitting people over the head with the idea. It allows people to think through parallels in their own work and to take initiative.

      That’s way better than a slogan campaign of “Go Above and Beyond!” or something like that. I think it’s clear Dr. Deming wouldn’t like an empty slogan campaign without the right environment that allows people to take initiative.

  3. Steve:

    I agree! Part of why it works so well is that rather than exhort, it asks an open-ended question. Poster as Socratic teaching tool. The employee in the picture answers the question but we, also, are invited to respond and we learn something by shaping our answer. Nice!

  4. Health care staff are struggling with increasing workloads. However, a smile and a short conversation goes a long way towards patient satisfaction, which will definitely impact a hospital’s bottom line. Plus, doesn’t it just make everyone happier if they are able to brighten someone’s day?


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