Tuesday, December 16, 2008

PI/QI: Theological Reflections (6)

(This post is the last in a series on theological reflection on Performance Improvement/Quality Improvement. Original material for this series was first published in “Performance Improvement: Theological Reflections”, Chaplaincy Today, Vol. 16, Number 1 (Summer, 2000), and has been reedited for this setting. The information in this post is new for this series. For other posts in this series or in the series on measurement for chaplains, please select the label "PI/QI" in the left hand column.)

Performance Improvement: Theological Reflections, Part 6

Not long ago I attended my first CREDO Conference. CREDO is an initiative for wellness sponsored by the Church Pension Fund of the Episcopal Church. While it was initially oriented specifically to priests at various stages of life and ministry, there have now been CREDO Conferences for bishops, and will soon be conferences sponsored by the Presbyterian Church USA.

During the conference leaders introduced a four-step process for making plans and decisions. CREDO addresses a priest's ministry from a variety of perspectives - Health, Finances, Spirituality, Vocation, and - - and this tool was suggested as useful in each category, as well as in general.

As referenced in the CREDO 2007 Annual Report, the four steps are:

Identity: who am I?
Discernment: what are my priorities?
Practice: what is my plan?
Transformation: how am I changing?

The process as taught by CREDO is in language familiar to clergy. Indeed, they would be particularly comfortable for those of us with clinical training. We are, after all, trained to discern who we are, both in our identities and within our faith traditions, and to incorporate that discernment into our practice so as to see opportunities for transformation, both for ourselves and for those we serve.

When I heard this four-step process, it rang a bell. It was remarkably like the four step process for quality improvement, commonly known as the "Deming Model," after Dr. Deming. As described by the American Society for Quality, those four steps are:

Plan-Do-Check-Act Procedure
Plan. Recognize an opportunity and plan a change.
Do. Test the change. Carry out a small-scale study.
Check. Review the test, analyze the results and identify what you’ve learned.
Act. Take action based on what you learned in the study step: If the change did not work, go through the cycle again with a different plan. If you were successful, incorporate what you learned from the test into wider changes. Use what you learned to plan new improvements, beginning the cycle again.

Now, these two four step schemes were not developed together, and are not perfectly analogous. However, it seems to me that they line up rather well:

Plan is very similar to Discernment. What are the opportunities available, and which seem to me to express priorities I agree with? Another way to consider it would be to recognize that it is my priorities that will determine what opportunities I see and which I might choose among those opportunities.

Do is similar to Practice. We are exploring opportunities and testing out new behaviors that express our priorities.

Check is similar to Transformation. We observe how things are changed – for the minister, how we are changed - as a result of or in the context of the opportunities and new behaviors we have practiced.

Finally, Act is similar to Identity. That is, the step Act in the Deming Cycle is one of appropriation and integration. It is the recognition and embracing of identity, which we may find either reaffirmed or re-understood in light of the changes we have implemented. And, in light of that recognition, we will likely also understand anew our priorities and see new opportunities.

Finally, while they are not exactly analogous and do line up perfectly, each is a cycle. Moreover, each is presented as a discipline for life, and not simply for a single decision or problem. So, while we may enter the cycle at different points, if we work our ways through steps in order we will see either program through, and will be able to continue going forward.

Here, then, is a process for growth in ministry that is remarkably congruent with the Deming Cycle for quality improvement. The terms are familiar and useful to us in ministry. In our efforts to appreciate the concept of Performance/Quality Improvement for our work as chaplains the contemporary model offered by the CREDO Program would seem remarkably timely and apt.


Certainly, the reflections in this series are incomplete, places only to begin. However, I have found them helpful in my own reflection and offer them in the hope that they will be helpful to others. These reflections are models, with the limitations implied in that concept. They hold similarities and differences, congruities and incongruities. However, they can provide handles with which to come to grips with the concepts.

Performance improvement is and will continue to be an important concept in health care. With important accrediting organizations using it as a standard for measurement, our institutions cannot ignore it. If they cannot, neither can we, if we are to carry out our ministries fully. As a profession, and as professionals, we must begin the discussion on this important concept. In this way we will serve well our institutions and associates and ultimately our patients.

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