Theories Underpinning Quality
Iain Lamb - Associate Adviser SE Scotland
Pirsig’s metaphysics of Quality (MOQ) is a theory of reality introduced in
Robert Pirsig’s novel, "Zen and the Art of Motorcycle Maintenance" (1974)
“The place to improve the world is first in one's own heart and head and hands.”
“Quality is a direct experience independent of and prior to intellectual abstractions.”
Pirsig describes Quality but says it cannot be defined because it precedes any intellectual
constructions. It is the "knife-edge" of experience that is known to all and Pirsig believes
that Quality is the fundamental force in the universe stimulating everything from atoms to
animals to evolve and incorporate ever greater levels of Quality. According to the MOQ,
everything (including the mind, ideas, and matter) is a product and a result of Quality.
The MOQ divides Quality into two forms: Static quality is patterned and Dynamic
Quality unpatterned and together make up all of reality. Initially unpatterned quality is at
the cutting edge but will eventually turn into one of four static patterns.
Dynamic Quality
Dynamic Quality includes everything not static. I think of Dynamic Quality as being
intuitive, original, creative, spontaneous and difficult to describe. The quality that comes
from within drives us to achieve excellence. In the consultation it is what makes doctors
able to move from Schon’s knowing in action to reflection in action. It takes a student
watching that surgery outwith the static quality of their curriculum and into areas that are
much less measurable. Dynamic Quality is the force of change in the universe; when this
aspect of Quality becomes habitual or customary, it becomes static. Pirsig called
Dynamic Quality "the pre-intellectual cutting edge of reality" because it can be
recognized before one can think about it. This means that Quality lies in the moment we
sense anything and we give this impression a static form by describing it as an emotion,
thing or word for example. These static forms, if they have enough good or bad quality,
are given names and are interchanged with other people, building the base of knowledge
for a culture. And different cultures will have different ways of understanding and
explaining quality. For example Eastern and Western cultural understanding of quality
values can be very different. The leading Western authors on quality post war talked
about quality in management and what was required by customers. Demming amongst
others interpreted Japanese quality in this way but it is in fact significantly different from
the Japanese view that “Quality relates to universal harmony” I mention Demming’s 14
principles later and there are aspects of them that are useful and interesting. They
describe many of the qualities sought within medicine and education. They tend to be
measurable and have a clear structure that can drive political and managerial needs.
However don’t mistake it for the quality that comes from our own heart, head and hands.
Less exclusive, objective study of how things are done and more inclusive Dynamic
study of how to do them: that is; less literature and more creative writing, less art
appreciation and more art, less philosophology (i.e. the history of philosophical ideas)
and more philosophising. The idea of the scholar as someone who knows much but
cannot do anything weakens respect for all academia. (Pirsig 2002 on his website in
dialogue with Dr Anthony McWatt – (A philosopher’s perspective of the auditing
procedures in UK Higher Education)
He also quotes Professor Philip Tagg who uses words like ‘Curiosity, enthusiasm, the
ability to cooperate, intellectual generosity, artistic independence, originality, innovation
and many other unquantifiable qualities essential to good education and research.’ when
discussing Dynamic quality. Many of these things are intuitive and difficult to describe
and assess. Most assessment of our work now thinks of quality as a rather abstract
requirement for regulation and accountability rather than as a pursuit of excellence. And
with the gain of very small percentage numbers of very poor assessments there has been a
loss of trust in the very many teachers who have had an internal drive towards excellence.
Dynamic quality is being lost and the lower levels of static quality measured ad
infinitum.
Static quality patterns
Pirsig defines static quality as everything that can be conceptualized or recognized as
forming patterns. Pirsig further divides static quality into inorganic, biological, social,
and intellectual patterns, in ascending order of morality. And they are exhaustive. That’s
all there are. Pirsig says that if you construct an encyclopaedia of four topics - inorganic,
biological, social and intellectual - nothing is left out. No ‘thing’, that is. Only Dynamic
Quality, which cannot be described in any encyclopaedia is absent.
*Inorganic patterns: non-living things
*Biological patterns: living things
*Social patterns: behaviours, habits, rituals, institutions.
*Intellectual patterns: ideas
Pirsig describes evolution as the moral progression of these patterns of value with
intellectual being the highest. Pirsig claimed that the traditional Subject-Object
Metaphysics (SOM) of Western philosophy and science is problematic because it does
not clearly recognize the superior morality of intellect over society, and society over
biology, by its artificial distancing of the subject from the object, of fact from value.
Pirsig claims that it is the conflict between the newly dominant intellectual patterns and
the (previously dominant) social patterns that have led to many of the problems of the
20th century.
This is a very different way of looking at quality than has developed over the past 20
years with its focus on the measurable often lower value patterns. Does all the time now
spent measuring, auditing, setting standards push up true quality or just act as a way of
ensuring the very small percentage of very poor quality is found and acted upon.
Example – It may not be high quality example but most of it flowed and made intuitive
sense: I am very interested in Jazz piano and travelled to a concert in London. I came out
feeling inspired and thinking I’d been to one of the highest quality concerts of my life.
When asked to explain why it was so good I found it impossible to describe. It was just
fantastic. When I thought about this in more detail I had to break it down into static
quality terms to try and convey a small part of what the quality really meant.
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Inorganic – The piano was superb and the auditorium had excellent acoustics
Biological – the trio interaction and interplay was awe inspiring. The pianist gave
absolutely all his effort and emotions to each piece
Social – There was full house of people sharing an interest and enthusiasm and an
intensity of involvement that seemed to inspire the solos and a shared rapture at
the end. So it was a shared experience.
Intellectual – later listening to the recording of the concert I identified the quality
of the harmonic and rhythmic underpinning of the music and the melodic flow
throughout all the pieces. But the true genius was how much of the music was
improvised at a level I could only dream about.
Pirsig explains his philosophy much more articulately on his website robertpirsig.org/
As an example I quote one of his paragraphs
“As to which is more important, Dynamic or static, both are absolutely essential, even
when they are in conflict. Without Dynamic Quality an organism cannot grow. But
without static quality an organism cannot last. Dynamic liberals and radicals need
conservatives to keep them from making a mess of the world through unneeded change.
Conservatives also need liberals and radicals to keep them from making a mess of the
world through unneeded stagnation.”
Herzberg's Motivation-Hygiene Theory
To better understand employee attitudes and motivation, Frederick Herzberg performed
studies to determine which factors in an employee's work environment caused
satisfaction or dissatisfaction. He published his findings in the 1959 book The Motivation
to Work.
The studies included open question interviews in which employees where asked what
pleased and displeased them about their work. Herzberg found that the factors causing
job satisfaction were different from those causing job dissatisfaction. He developed the
motivation-hygiene theory to explain these results. He called the satisfiers motivators
and the dissatisfiers hygiene factors. He considered hygiene to mean maintenance
factors that are necessary to avoid dissatisfaction but that by themselves do not provide
satisfaction.
The following table presents the main factors causing dissatisfaction and the top main
ones leading to satisfaction, listed in the order of higher to lower importance.
Factors Affecting Job Attitudes
Causing Dissatisfaction
Company policy
Supervision
Relationship with supervisor
Work conditions
Salary
Relationship with peers
Personal life
Relationship with subordinates
Security
Status
Leading to Satisfaction
Achievement
Recognition
Work itself
Responsibility
Advancement
Growth
Herzberg reasoned that because the factors causing satisfaction are different from those
causing dissatisfaction, the two feelings cannot simply be treated as opposites of one
another. The opposite of satisfaction is not dissatisfaction, but rather, no satisfaction.
Similarly, the opposite of dissatisfaction is no dissatisfaction.
While at first glance this distinction between the two opposites may sound like a play on
words, Herzberg argued that there are two distinct human needs portrayed. First, there are
physiological needs that can be fulfilled by money, for example, to purchase food and
shelter. Second, there is the psychological need to achieve and grow, and this need is
fulfilled by activities that cause one to grow.
Managing using hygiene factors is the process of providing incentives or a threat of
punishment to cause someone to do something. Herzberg argues that these provide only
short-run success because the motivator factors that determine whether there is
satisfaction or no satisfaction are intrinsic to the job itself, and do not result from carrot
and stick incentives.
For motivation-hygiene theory to work, not only must hygiene factors be addressed to
avoid employee dissatisfaction, but also factors intrinsic to the work itself in order for
employees to be satisfied with their jobs. And it is the latter that provides long term gain.
Herzberg argued that job enrichment is required for intrinsic motivation, and that it is a
continuous management process. According to Herzberg:
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The job should have sufficient challenge to utilize the full ability of the employee.
Employees who demonstrate increasing levels of ability should be given
increasing levels of responsibility.
If a job cannot be designed to use an employee's full abilities, then the firm should
consider automating the task or replacing the employee with one who has a lower
level of skill. If a person cannot be fully utilized, then there will be a motivation
problem.
Although there are critics who say this model is simplistic I find it useful when working
with trainees at a number of levels.
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Understanding the many patients who come to the GP because of work related
stress.
As a way of looking at the dynamics of the practice as a business and employer
and to observe the areas of satisfaction and dissatisfaction.
When helping explore future career plans and finding the right practice for
example.
To analyse some of the things that influence work life balance
It also links with a range of other models that we use in teaching. For example:
 Maslow and one way I think about Herzberg’s theory is with the “hygiene factors
as the foundation” and the “motivators” as a pyramid ascending to achievement.
 Motivational interviewing and how long term change comes from within
 The 7 habits of Effective People – Covey and that effectiveness is not just about
production but also production capacity. Don’t kill the goose that lays the golden
egg.
Sometimes it feels like budget cuts and a drive towards a competence rather than
capability quality is killing the enthusiasm of the educators. Fortunately we’re a
pretty resilient bunch – reflecting on a strong motivation led work ethic.
Research by Development Dimensions International published in the Times newspaper in
2004 interviewed 1,000 staff from companies employing more than 500 workers, and
found many to be bored, lacking commitment and looking for a new job. Pay actually
came fifth in the reasons people gave for leaving their jobs. The main reasons were lack
of stimulus jobs and no opportunity for advancement - classic Herzberg motivators - 43%
left for better promotion chances, 28% for more challenging work; 23% for a more
exciting place to work; and 21% and more varied work.
We don’t always recognise it but we are lucky in General Practice to have challenging,
exciting and varied work. There is no need for promotion and we are well paid.
McGregor's X-Y theory
This is a salutary and simple reminder of the natural rules for managing people, which
under the pressure of day-to-day work are all too easily forgotten. It augments
Herzberg’s work and helps us look at how to maintain Quality in the work place.
Douglas McGregor in his book “The Human Side of Enterprise” written in 1960
maintained that there are two fundamental approaches to managing people. Many
managers tend towards theory x, and generally get poor results. Enlightened managers
use theory y, which produces better performance and results, and allows people to grow
and develop.
Theory x ('authoritarian management' style)
 The average person dislikes work and will avoid it if he/she can.
 Therefore most people must be forced with the threat of punishment to work
towards organisational objectives.
 The average person prefers to be directed; to avoid responsibility; is relatively
unambitious, and wants security above all else.
Theory y ('participative management' style)
 Effort in work is as natural as work and play.
 People will apply self-control and self-direction in the pursuit of organisational
objectives, without external control or the threat of punishment.
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Commitment to objectives is a function of rewards associated with their
achievement.
People usually accept and often seek responsibility.
The capacity to use a high degree of imagination, ingenuity and creativity in
solving organisational problems is widely, not narrowly, distributed in the
population.
In industry the intellectual potential of the average person is only partly utilised.
I also consider the situational leadership model of Blanchard and Hersey when thinking
of black and white models like this one. Basically good leadership and management
depends on the flexibility of the leader to identify whether someone needs more directive
or supportive approaches.
Deming's 14 Principles
Dr W. Edward Deming's presented this in his book of 1993 Out of the Crisis.
1. Constancy of purpose: Create constancy of purpose for continual improvement
of products and service to society, allocating resources to provide for long range
needs rather than only short term profitability, with a plan to become competitive,
to stay in business, and to provide jobs.
2. The new philosophy: Adopt the new philosophy. We are in a new economic age,
created in Japan. We can no longer live with commonly accepted levels of delays,
mistakes, defective materials and defective workmanship. Transformation of
Western management style is necessary to halt the continued decline of business
and industry.
3. Cease dependence on mass inspection: Eliminate the need for mass inspection
as the way of life to achieve quality by building quality into the product in the
first place. Require statistical evidence of built in quality in both manufacturing
and purchasing functions.
4. End lowest tender contracts: End the practice of awarding business solely on
the basis of price tag. Instead require meaningful measures of quality along with
price. Reduce the number of suppliers for the same item by eliminating those that
do not qualify with statistical and other evidence of quality. The aim is to
minimize total cost, not merely initial cost, by minimizing variation. This may be
achieved by moving toward a single supplier for any one item, on a long term
relationship of loyalty and trust. Purchasing managers have a new job, and must
learn it.
5. Improve every process: Improve constantly and forever every process for
planning, production, and service. Search continually for problems in order to
improve every activity in the company, to improve quality and productivity, and
thus to constantly decrease costs. Institute innovation and constant improvement
of product, service, and process. It is management's job to work continually on the
system (design, incoming materials, maintenance, improvement of machines,
supervision, training, retraining).
6. Institute training on the job: Institute modern methods of training on the job for
all, including management, to make better use of every employee. New skills are
required to keep up with changes in materials, methods, product and service
design, machinery, techniques, and service.
7. Institute leadership: Adopt and institute leadership aimed at helping people do a
better job. The responsibility of managers and supervisors must be changed from
sheer numbers to quality. Improvement of quality will automatically improve
productivity. Management must ensure that immediate action is taken on reports
of inherited defects, maintenance requirements, poor tools, fuzzy operational
definitions, and all conditions detrimental to quality.
8. Drive out fear: Encourage effective two way communication and other means to
drive out fear throughout the organization so that everybody may work effectively
and more productively for the company.
9. Break down barriers: Break down barriers between departments and staff areas.
People in different areas, such as Leasing, Maintenance, Administration, must
work in teams to tackle problems that may be encountered with products or
service.
10. Eliminate exhortations: Eliminate the use of slogans, posters and exhortations
for the work force, demanding Zero Defects and new levels of productivity,
without providing methods. Such exhortations only create adversarial
relationships; the bulk of the causes of low quality and low productivity belong to
the system, and thus lie beyond the power of the work force.
11. Eliminate arbitrary numerical targets: Eliminate work standards that prescribe
quotas for the work force and numerical goals for people in management.
Substitute aids and helpful leadership in order to achieve continual improvement
of quality and productivity.
12. Permit pride of workmanship: Remove the barriers that rob hourly workers, and
people in management, of their right to pride of workmanship. This implies,
among other things, abolition of the annual merit rating (appraisal of
performance) and of Management by Objective. Again, the responsibility of
managers, supervisors, foremen must be changed from sheer numbers to quality.
13. Encourage education: Institute a vigorous program of education, and encourage
self improvement for everyone. What an organization needs is not just good
people; it needs people that are improving with education. Advances in
competitive position will have their roots in knowledge.
14. Top management commitment and action: Clearly define top management's
permanent commitment to ever improving quality and productivity, and their
obligation to implement all of these principles. Indeed, it is not enough that top
management commit themselves for life to quality and productivity. They must
know what it is that they are committed to-that is, what they must do. Create a
structure in top management that will push every day on the preceding 13 Points,
and take action in order to accomplish the transformation. Support is not enough:
action is required!
Demming along with others also developed the Plan, Do, Study, Act cycle which is
mentioned later.
Kaizen
Kaizen (Japanese for "improvement" or "change for the better") refers to philosophy or
practices that focus upon continuous improvement of processes in business and
management and has been applied to healthcare and education. When applied to the
workplace, kaizen refers to activities that continually improve all functions, and involves
all employees from the boss downwards. By improving standardized activities and
processes, kaizen aims to eliminate waste and was driven by Japanese businesses
influenced by American quality management teachers such as Demming after the Second
World War.
Kaizen goes beyond simple productivity improvement and should nurture the company's
human resources and involve workers in the improvement. Kaizen usually delivers small
improvements which are monitored with the aim of making larger improvements in the
long run and improve the quality of the process and outcomes.
The cycle of kaizen activity can be defined as:
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Standardize an operation
Measure the standardized operation
Gauge measurements against requirements
Innovate to meet requirements and increase productivity
Standardize the new, improved operations
Continue cycle ad infinitum
Another similar cycle with a structural management formula is SIX SIGMA which looks
at work process and how they might be improved and their quality measured. It was
developed because of perceived poor quality in the Motorola Company in the late 1970’s.
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Define the problem
Measure the current situation from all available data
Analyse and find the root cause
Improve the situation
Controls put in place to
maintain improvement
It is built on the PDSA sometimes
known as the PDCA cycle looking at a
management cycle purporting to pursue
quality. (Demming and Shewhart)
Positives of Kaizen
 Teamwork and communication
 Personal discipline
 Improved morale
 Quality circles and willingness to
change
 Suggestions for improvement
ACT
PLAN
STUDY
or
CHECK
DO
CHECK
Criticisms of Kaisen
 Overwork because expectation do extra in own time.
 Excess price cuts and workload
 Safety compromised so increased risks
 Hospitals have used these streamlining procedures as an excuse to cut patient-care
staff etc
 Kaizen is supposed to involve input from all employees but critics say often this is
just lip service.
 Because it identifies things that can be measured it encourages measurable quality
rather than more elusive qualities that are difficult to measure.
Ishikawa diagrams
Ishikawa, Kaoru (1990); (Translator: J. H. Loftus); Introduction to Quality Control; 448
p; ISBN 4-906224-61-X OCLC 61341428
These are basically fishbone diagrams but using the following headings to analyse the
effect of problems and quality outcomes.
 People: Anyone involved with the process
 Methods: How the process is performed and the specific requirements for doing
it, such as policies, procedures, rules, regulations and laws
 Machines: Any equipment, computers, tools etc. required to accomplish the job
 Materials: Raw materials, parts, pens, paper, etc. used to produce the final product
 Measurements: Data generated from the process that are used to evaluate its
quality
 Environment: The conditions, such as location, time, temperature, and culture in
which the process operates
 Management: Style, responsibility, decision making.
The headings are written in the blue
area and the problem and what effect it
is having is described in the pink area.
Ishikawa also envisioned using this
diagram to look at quality outcomes
and how you need to define what is
required under each of these headings
to provide quality. This could also be
thought of as looking at cause and
effect.
Then either by brainstorm or discussion issues relevant to each heading are written down
and linked to the relevant fishbone.