Here are some ideas I picked up from chapter 7 (Quality Management in Military Medicine) of Chip Caldwell's Handbook of Managing Change in Health Care:
1. "Throwing money at a problem usually only makes it worse"
2. Crisis management is bad. It is used to demonstrate that something is getting done. It causes processes to break down and for people to make shortcuts in order to save time. "Quick productivity takes precedence over quality".
3. "The fear or inability to say no in an organization is enormously destructive to any QM initiative. It immediately creates distrust and stifles productive feedback. Employees are fearful of being fired. Exposing any weakness or faults labels the employee as a troublemaker. Employees are then very distrustful of any management scheme that talks about empowerment. If they don't see empowerment or trust in action, they will correctly decide that it doesn't really exist. If their evaluations are based on the quantity of work performed, process improvement will be seen as a waste of time. Their view is, 'Why spend the time required to fix processes?' For them, management's over-focus on short-term tasks or projects give visible (but false) evidence that real work is being done."
I find this last item particularly true. It is interesting that this comes from a chapter about quality in military medicine, as I once heard someone say that calling CNAs the 'front line' makes it sound as if we are fighting a war. Perhaps we are.