Week 5 Post - Total Quality Management Changes and Getting to the Heart of Change

One thing that really interests me in my work in health care is quality improvement (QI).  Pfeffer and Sutton (2006) touched upon quality improvement efforts as a potential dangerous organizational change.  Pfeffer and Sutton (2006) stated, "Six Sigma and Total Quality Management (TQM) efforts can increase quality and incremental innovation.  But focusing on tiny improvements in old systems can distract management attention and resources from the big picture" (p163).  Oftentimes TQM turns out to be only talk with maybe some minimal training and no action on the improvement project (Pfeffer & Sutton, 2006).  Studies say the increase in TQM as a business hot topic came after TQM turned into a fad (Pfeffer and Sutton), 2006.  Quality improvement can be a great tool when utilized correctly.  I think that if there is scientific evidence behind an improvement initiative it is worth the discussion and possible training of staff if it yields a positive result.  For example, my fellowship project at work is to decrease hospital-acquired pressure ulcers (HAPUs) in patients who are stuck in bed due to devices present to assist their cardiac/pulmonary systems.  We are trialing a prophylactic dressing to help relieve pressure on patients' coccyx.  The trial came about after I read some scientific evidence-based articles that, according to the literature, patients had a decrease in HAPUs with the dressing in place.  I think a big part of TQM and QI is to have staff involvement in order to have successful outcomes the initiatives.  My project probably would not have gotten done if I did not initiatie it and get the rest of the staff on board by making a persuasive argument - patient safety.  Have you ever tried implementing a quality improvement where you work?  Do you think it is a dangerous organizational change or is it something critical to organzational survival?

The other concept that from week 5 that was interesting was the John Kotter's video 'The Heart of Change.'  I found his points about driving change and successful implementation take more than just getting people to think about the change.  The people need to feel the change.  He points out that when trying to get people on board with new changes the focus on thinking/feeling is usually only 90/10 maybe 80/20 at best.  By getting people more emotionally involved with the changes, the potential for successful change implementation is greater.  This is important for managers because as he pointed out in a later video, the frequency of change within organizations is increasing.  The most difficult portion of implementing a change is getting staff to follow and support the change.  By driving the feeling component of selling a change, a manager would be able to get more people on board to help drive the change.  Have you ever resisted change from within your organization?  Do you think implementing change should be easier or is it almost a natural response to have employees resist change?
The article, "Good Leaders Persuade. They Don't Manipulate" (2014) by Harrison Monarth discusses the importance of making sure that leaders persuade members of their staff versus using manipulative tactics like, 'you get to keep your job.'  While this does not directly relate to change or TQM, it does help with the ways to implement the two concepts which are very similar to one another.  Monarth points out that, "[m]anipulators are heard, but persuaders are believed because they are trusted."  In addition to that strong quote, he highlights other differences between manipulation and persuasion, all of which are great points, but none of which are scientific-based.  I think if there were some strong evidence-based points this article could turn into a great QI development.  The recommendations though are fact based with definitions of words and concepts.
Next week I look forward to learning about HR issues since that has been a hot topic in my work environment over the last 4 years.  I am also excited to start wrapping up the team project and seeing how it looks when it is complete.  This past week was a great week for me as change is such a huge issue to overcome, particularly for nurses.  The Mind Tools website discusses Change Management and has a change tool box with tools to help understand, plan, implement, and communicate change.  A lot of the additional websites I looked at reference Kotter's 8-Step Change Model, which I would have included, except it was already listed on the course website.


Monarth, H. (2014). Good Leaders Persuade. They Don't Manipulate. Entrepreneur. Retrieved from: http://www.entrepreneur.com/article/235320
Pfeffer, J. & Sutton, R. I. (2006). Hard facts, dangerous half-truths, and total nonsense: profiting from evidence-based management. Boston, Mass.: Harvard Business School Press.