EBM CQI Article of the Week 6.29.21

From Marvin Weisbord’s Productive Workplaces, he of Six Box Theory,…..reflecting upon his career and theory of creating meaningful organizational change:

I would do this work again because I believe that:

  • Dialogue and inquiry are good for us.
  • Human workplaces enjoy greater economic success.
  • Helping people gain control of their work engenders hope, and we need hope to get by.
  • It is existentially right to encourage cooperation – social, technical, and economic – across lines of age, class, culture, education, ethnicity, gender, national borders, race, status and occupation.

Finally, I would do this work again for the sake of future generations.  Everyone improving the whole is a legacy from the ancestors honored [in my writings],….our descendants richly deserve this legacy.”

BTW, his ‘Six Box Theory’:  1) Purposes, 2) Structure, 3) Relationships, 4) Rewards, 5) Helpful Mechanisms, 6) Leadership.  Our inability to make consistent progress in quality, safety, value, and satisfaction, Weisbord argues, reside in one or more of these six boxes.

I would modify his meaning of “relationships’ to something more fundamental than just human interactions/emotions/communication,…..and argue that the very nature of life, the entire universe, all matter/energy/things, are in fact interaction-relationships.  Not just humans and sentient creatures, but a table, a mountain, an apple, an atom, a quark.

Anything that is not interacting with some other thing does not exist to us.  We don’t comprehend anything as thing-in-itself,.…….we only sense a tree, a shirt, a best friend, a book, a neutrino by its interaction with another “thing”.  And that is why (my opinion) authentic quality improvement science is not pyramids, hierarchies, rules, and static protocols.  Successful QI is 3-D networks of node-interactions (which includes Weisbord’s “relationships”).

More on that metaphysical bedrock coming,…….meanwhile, why do we charge families for childbirth?  Average $3000 out-of-pocket, with private insurance.  Even more if the NICU is used.  My nominee for the perfect droll understatement of 2021 thus far –  page 3, bottom, middle column.

Joe Kaempf, MD
District VIII Oregon Representative
Portland, OR

Volume 13, Number 21

https://pubmed.ncbi.nlm.nih.gov/34140392/

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