3 Steps to Improve Quality and Safety

March 5, 2018
Mike Stallard

Mistakes and accidents can literally be a matter of life and death in certain industries. Workers in healthcare, construction, aerospace/defense, airline and automobile manufacturing, for instance, must be highly attuned to eliminating mistakes and accidents. Presently, the healthcare industry is experiencing alarming rates of physician burnout, which research has shown contributes to accidents that affect patient outcomes. In hyper-competitive industries such as manufacturing and retail, minimizing the waste from mistakes is essential to maintaining price competitiveness.  For others, mistakes and accidents can negatively impact the customer experience or damage the organization’s reputation.

To address quality and safety issues, many “programs” adopted by organizations over the years have focused on tasks but overlook the important role that relationships play in these matters. When relationships in the workplace are disconnected, lukewarm, strained or even toxic, people don’t give their best efforts, they don’t align their behavior with the team’s goals, they don’t communicate or collaborate as well as they should, and they tend not to make the effort to be creative and innovate. These areas of sub-optimal performance sabotage quality and safety.

In general, most managers are intentional about achieving task excellence, but they fail to be intentional in achieving relationship excellence. This failure sabotages task excellence every time. When relationship excellence is present, however, everyone pulls together to make progress. This easy-to-remember model captures it: Task Excellence + Relationship Excellence = Sustainable Superior Performance.

Here are three steps to improve quality and safety by being intentional about achieving both task excellence and relationship excellence. 


Begin the process with an attitude of humility. Improving quality and safety requires an individual and collective mindset that acknowledges the necessity of day-to-day continuous effort and realizes that losing focus is all that is required for mistakes and accidents to pop up like weeds. 

It’s also important to recognize that “lone rangers” can’t do this; teams must work together to maximize quality and safety. Team members encourage one another to be diligent and help each other identify and address blind spots that might be compromising the team’s quality and safety efforts. Together, recognize that your team always needs to improve and that team effort is required to make substantial progress.


Task excellence requires measuring quality and accidents, identifying gaps, seeking ideas and opinions of employees in how to close gaps, implementing the best ideas, and giving credit where credit is due.

Relying on your own intuition can result in self-deception. To measure is to be humble and realistic. Measurement is necessary to bring objectivity, although we should not idolize the resulting metrics. 

When metrics are unfavorable and there is a gap from the desired number, it should trigger an investigation to understand why the gap exists and what is required to close it. Go to people on the front line closest to the activity, share the data, and sincerely ask for their ideas and opinions on how the team can close the gap. Implement the best ideas and be sure to give credit where it’s due. That simple step of acknowledging the contribution of others, especially if done publicly, will encourage future engagement.  

When complex tasks are involved, checklists are necessary. The airline industry has developed checklists and it has reduced incidents of pilot error. There is a movement to use checklists in healthcare too. This also requires humility to acknowledge that we can easily forget mundane but essential steps. 


Relationship excellence requires creating a "Connection Culture," which research has shown reduces accidents by 20-48 percent.

Johns Hopkins Hospital developed a checklist for teams performing open heart surgery. One step on the checklist was for each person on the surgical team to introduce himself or herself, describe his or her role, and explain any potential complications to be on the lookout for. Research found that when surgical team members followed
these steps, individuals with lower power and status on the team (typically non-physicians) were more likely to speak up if they saw problems, which helped the team perform better and achieve superior patient outcomes. These steps helped create relationship excellence and a Connection Culture among the surgical team members. 

Hard data confirms the effect of connection on improving quality and safety. Gallup’s research of 49,929 work units, comprising 1.4 million employees within 192 organizations across 34 nations, found that top quartile units that self-reported being the most connected experienced 41% fewer quality defects and 48% fewer safety
accidents versus units in the bottom quartile of connection metrics. Those are staggering differences in performance. Neuroscience helps explain why the degree of connection matters.  

Chronic, continuous feelings of stress shift brain activity from the frontal lobes of the brain, where rational decisions are made, to the mid-brain, where rash decisions are
more likely to be made. In addition, chronic stress enhances the performance of the “fight or flight” systems of the body (i.e. heart, lungs and big muscles such as thighs) but compromises these four important bodily systems: the part of the brain where short-term declarative memory is processed (i.e., the hippocampus), the digestive system, the immune system and the reproductive system. If we are stuck in stress response, then we don’t feel well, we don’t sleep well and our energy is drained over time. Eventually exhaustion sets in, which makes mistakes and accidents more likely to occur.  

Team members who feel connected to each other are more likely to be protected from the corrosive effects of stress. Having supportive relationships in which individuals feel connected to one another and the work, feel valued for what they contribute and bring to the whole, and feel their voice is heard and appreciated fosters relationship excellence.


In summary, organizations that desire high levels of quality and safety must be intentional about creating a culture that achieves both task excellence and relationship excellence. If they do, sustainable superior performance is achievable.  

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Michael Lee Stallard, president and cofounder of Connection Culture Group, speaks, teaches and consults on leadership, organizational culture and employee engagement. He is the author of Connection Culture and Fired Up or Burned Out. Follow him on his blogTwitterFacebook, or LinkedIn.

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