Tuesday, August 21, 2012

The Professional Mandate Pt2: Continuous Improvement, No Regession

Previously, I've defined the central aspect of the Professional Mandate as:
Its "unprofessional" to repeat, or allow, Known Faults, Failures and Errors.
Which is the Deming/Shewart Quality Improvement Cycle: PDCA (Plan-Do-Review-Improve System, also Plan-Do-Change-Act).

All Quality, Safety and Performance Improvement programs share must contain these 4 elements and have a central element in common:
Conscious, deliberate learning and adaption.
Improvement is not accidental: If you don't design it in, why would you expect it to show up?

There is another, personal, factor underlying Quality and Professional Improvement:
Caring comes first.
Which is not quite a restatement of "Professionals owe a Fiduciary Duty to their Clients". Caring is an unforced, voluntary internal state, Duty is an an imposed external obligation. Good Professionals not only have to perform well, they want to.

More specifically, Professionals must both Care about the Client Outcomes they produce and how well they do job they do. Good Professionals aim, every day for every task, to produce their best performance and provide Perfect Client Outcomes.

Perfect Client Outcomes are NOT "Perfectionism" nor unrealistic and unachievable. It's not about a Perfect Performance, execution without flaw, impossible by definition for Real People ("To Err is Human") but about the Client Outcome:

  • Perfect for the Client may be getting any help whatsoever.
  • Perfect for the Client may be getting "Good Enough" service in a timely manner.
  • Perfect for the Client may be resolving an issue within a time-frame.
  • Some some Clients, Perfect is As Cheap as Possible or Really Close and Accessible,
  • whilst the PT Barnum rules also applies: You can please some of the People some of the time, but not all of the People, all of the time.
    • For some Clients, no outcome will ever be deemed by them to be Perfect.
The execution of a Professional Service may contain Errors, in fact you'd expect (small) Errors every time, but the System and Process creating the Client Outcome need to be tailored to noticing them before they can affect the Outcome and in preventing consequential effects.

It's OK to make an error, so long as its corrected before it has an impact or creates damage. Trying too hard to Be Perfect degrades the Performance and Execution - we are not machines... This is the "secret sauce" known by Elite Sports Coaches:
Perfect is the enemy of Great, Perfectionism doesn't lead to Best.
Expanding notions introduced in Part 1:

  • Professionals must refuse directions and work demands that result in unsafe Practice, endangering clients or the public.
  • Doing The Right Thing must never penalised.
  • There are two sides to improvement: 
    • What not to do,
    • What to do.

Extending the rubric to include "and practice What Works (ie. proven)".

But there are two sides to this:

  • Adopting new Practices when proven superior,
  • Extinguishing old Practices when shown inferior.
There are research papers that conclude that for some "high standard" Professions:
  • It takes 15 years for proven new Practices to be adopted by even 50% of Practitioners, and
  • and 40+ years for old, inferior or disproven Practices to be phased out. Universally? not sure.
This work dovetails with the 1961 book, Science Since Babylon by Derek De Solla Price where he estimates the doubling period of Human Knowledge as shown by Journals and publications at 15 years and ties it in to the working lifetime of Scientists to arrive at his famous observation:
80-90% of all Scientists who have ever lived are alive today
The same 3 doubling periods of the average worklife also explains the time to give up old, inferior practices.

more to follow.

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