Some things should never be questioned. The world needs some absolutes and I find this especially true of quality management. During my more than 20 years of successful senior leadership and entrepreneurial experience in health care, I have come to appreciate the four absolutes of quality management as they were described by Philip B. Crosby. Below will be a narrative discussion of what they are and their relevance today.

I was seated in Cecelia's office. She asked me to inform you that she is 26, and the director of the pathology lab. She and I have been working several weeks on a project to smooth the lab's relationship with the emergency department.

We love to talk about food, and I just finished telling her about my new technique for making tamales when I got to the heart of why I was visiting, "So how is your project team going?" I asked.

She nodded like a bobble head and said, "Pretty good. We have had a couple of meetings and we are past the difficult stage of our team formation. There seems to be lack of consensus on what we are actually trying to accomplish."

My eyes widen for a moment. "Whoops. Then that is a failure on my part, Cecelia. I should have done a better job at explaining why we want improved relations between the two departments."

"I kind of understand," she said to acquiesce me.

"Again, Cecelia, this is a failure on my part, not yours. I did not do a good job giving the project that your team is undertaking enough weight. This is an important process in teambuilding"

My lips were tight and my forehead wrinkled. I stroked my chin as I thought. Cecelia sat quietly.

"Have you ever heard of a guy named Philip B. Crosby?"

"No," she answered. "Does he work at corporate?"

"No, no," I laughed. He was a fairly big deal with the development of Six Sigma."

She nodded. At one time, Six Sigma dominated all my conversations, not with just Cecelia, but everybody. She was probably afraid I would start talking about it again.

"Anyway," I continued, "He was very big in quality management. I believe that the labs relations with the emergency department fall under this category. We want a process in place that is efficient, back checks itself, and has zero mistakes."

Cecelia sat back a little, as if my presence had physically pushed her.

"I am serious, Cecelia. If your two departments make mistakes, people die."

She nodded softly.

"People die," I said again for emphasis.

"Okay, okay, I get it. You did not fail this time in explaining the importance of our project team," she said. "Now tell me about this guy Crosby."

"He believed very strongly in having senior leadership involvement. He developed the four absolutes of quality management."

Cecelia quietly positioned a piece of paper and got a pen ready. "The first one related to following or conforming to requirements," I said.

"We have enough of those," Cecelia said. "We will follow them."

"The second absolute,'" I continued, "comes from prevention. If you have a defect, you have already failed, so great emphasis is placed on preventing mistakes to begin with."

"Makes sense," she said to herself more than me.

"The third absolute is that our standard is zero mistakes, I said. "Not one or two a year, but zero, because if we make mistakes..."

"People die," she finished for me.

I nodded, "And the last one was that measurement, or tracking was because of nonconformance, or failure."

"We would not have anything to measure if we did not make any mistakes," Cecelia said softly.

"Right."

"So," Cecelia said, "Philip Crosby developed the four absolutes of quality management."

I nodded.

"They are, "She said.” Conform to requirements. Prevent mistakes. Zero mistakes is our goal, and measurements is the cost of nonconformance."

"Yes, on all accounts," I said. "You do understand why this project team is so important, then?"

"If we don't do our job, people die," she said sternly.

"Yes. Any further questions?" I asked.

"No, sir, Boss."

"Then I am out of here," I said standing. "Have a great day."

"You, too," and I was gone.

Thanks for reading.