Naar evidence based kwaliteitsmanagement

Al bijna twintig jaar loopt kwaliteitsmanagement als een rode draad door mijn adviesloopbaan. Ging het in de eerste jaren vaak over ‘moeten’: help ons aan een ISO-certificaat, de laatste jaren gaat het (gelukkig) vooral over ‘willen’: wij willen een stap zetten als organisatie, kwaliteitsmanagement kan daarvoor uitstekende handvatten bieden. Maar het kan nog een stap verder: kwaliteitsmanagement,  aantoonbaar van toegevoegde waarde! Het is echter een uitspraak die wel nader onderzoek vraagt…

Het vakgebied kwaliteitsmanagement heeft talloze technieken en methoden (en hypes…) voortgebracht: ISO 9001, TQM, INK/EFQM, Lean, Six Sigma, HKZ, NIAZ, erkenningsregelingen, werken met (kwaliteits)indicatoren, allerlei onderzoeken naar waardering door klanten en medewerkers, certificeringen, audits en visitaties, en ga zo maar door. Maar of je bij het besluit om een van deze methoden toe te passen in een organisatie kunt zeggen dat het bepaalde effecten of resultaten zal opleveren, daarover is nog verrassend weinig bekend.

Natuurlijk zijn daar wel beelden en ideeën over. Ik durf ook wel te stellen dat kwaliteitstrajecten in het algemeen meer inzicht geven in hoe een organisatie is georganiseerd en functioneert, verbeteringen in gang zetten, structuren verhelderen, interne communicatie verbeteren en leiden tot het gevoel dat men meer ‘grip’ heeft. Maar of klanten er ook echt beter van worden? Of de resultaten van een organisatie in brede zin verbeteren? Of organisaties écht effectiever en efficiënter worden?

Vanuit Het Zuiderlicht ben ik dit jaar met collega Marjan Hamstra gestart met ‘kwaliteit 0.0: magie van de eenvoud’. Een beweging die gaat over het toepassen van de fundamentele principes achter kwaliteitsmanagement en zichtbaar maken wat de resultaten van werken aan kwaliteit kunnen zijn. Een beweging naar ‘evidence based’ kwaliteitsmanagement. Juist in deze tijd van grote veranderingen (bijvoorbeeld in zorg en welzijn en het openbaar bestuur), waarbij grote vragen als ‘waartoe is onze organisatie er (nog)?’, ‘waar willen onze cliënten (en de maatschappij) voor betalen?’ en ‘hoe komen we tot een effectieve en efficiënte inrichting van onze organisatie?’ op tafel komen, kunnen deze fundamentele principes houvast en aanknopingspunten bieden. Zie hiervoor het verslag van een van de bijeenkomsten op www.hetzuiderlicht.nl.

Op meerdere gebieden zien we zo’n beweging naar meer ‘evidence based’ werken. De medische wereld is daarvan wellicht het bekendste voorbeeld: medicatie waarvan onderzocht is wat de werking is, behandelingen waarvan aantoonbaar is wat het effect is. Maar bijvoorbeeld ook op het gebied van ontwikkelingshulp is deze beweging zichtbaar: aantoonbaar maken wat de toegevoegde waarde is.

Het raakt overigens direct aan een bekend standpunt over evidence based werken: dan wordt alleen nog gewerkt met wetenschappelijk onderbouwde methoden en technieken. Dat is een misvatting. Uiteraard is dit wel één van de pijlers onder deze visie. Zie hiervoor www.cebma.org. Maar daarnaast hebben de praktijkervaringen van de betrokkenen (zoals de organisatieadviseur daar een van is) evenveel waarde. Evenals de beschikbare (management)informatie uit de organisatie en de visie en wensen van belanghebbenden. Om uiteindelijk te komen tot een besluit (om bijvoorbeeld een bepaalde interventie vanuit kwaliteitsmanagement toe te passen) op basis van de best beschikbare informatie, wat een positief effect heeft op de kwaliteit van de besluitvorming.

Het komend jaar geven we een vervolg aan Kwaliteit 0.0 en de beweging naar ‘evidence based’ kwaliteitsmanagement. Via bijeenkomsten, onderzoek, interviews en publicaties, maar uiteraard ook via het toepassen van dit gedachtegoed in onze adviestrajecten. De focus ligt daarbij op zorg en welzijn, gezien de ontwikkelingen in deze sector. En het doel is om te komen tot praktisch toepasbare inzichten die leiden tot antwoorden op de vraag: ‘kwaliteitsmanagement, wat hebben we er écht aan?’

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