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.
· 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 / Leading to SatisfactionCompany policy
Supervision
Relationship with supervisor
Work conditions
Salary
Relationship with peers
Personal life
Relationship with subordinates
Security
Status / 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:
· 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.
· 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.
· 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.