By February 18, 2010 6 Comments Read More →

Re-visiting Chapter 2 of Out of the Crisis (Part 1)

Continuing my series on re-reading Dr. W. Edwards Deming’s book Out of the Crisis, I’m posting a series of tweets from the Chapter along with my thoughts and comments. At about 70 pages, it’s a long, dense chapter, including Deming’s famous 14 points.

As much as Dr. Deming railed against targets, I had originally set a goal of reading one chapter a day. I’m not meeting that goal, so change of plan. I think there’s a huge difference in a personal goal versus a target dictated by management. Secondly, I’m not forcing myself to that arbitrary goal in the name of production over quality. I’m not skimming or speed-reading just to hit that goal. I’ve decided quality of reading is important than speed. I’m taking pride in my work…

#Deming said if you can improve sales by 5% next year without a rational plan, why were you not doing it last year? The folly of incentives.

Dr. Deming’s famous “by what method?” question always comes to mind. If you could get better performance just by asking for it, why didn’t you do that earlier?

#Deming said you can “beat horses and they will run faster -for a while.

#Deming “One requirement for innovation is faith that there will be a future.” We need leadership and no fear environment.

#Deming “Eliminate slogans, exhortations, and targets for the work force asking for zero defects and new levels of productivity.”

#Deming “Top mgmt should publish a resolution that no one will lose his job for contribution to quality and productivity.”

This idea is still practiced today in a number of manufacturing companies and hospitals that are adopting Lean methods, including D’Addario and ThedaCare. I wish more companies would realize how important this idea is, if you’re going to practice Lean, it’s all about employee participation, so why would they participate if they fear job loss?

#Deming “Routine 100% inspection to improve quality is equiv. to planning for defects, acknowledgment that the process” isn’t capable.

#Deming “Routine 100% inspection to improve quality is equiv. to planning for defects, acknowledgment that the process” isn’t capable.

#Deming “Routine inspection becomes unreliable through boredom and fatigue.” How many healthcare processes rely on 100% inspection?

This was my question about healthcare processes, not Dr. Deming’s. I got one response via Twitter that asked, “All of them?”  Healthcare relies far too much on people being careful. If one inspection failed, healthcare often adds a second. That’s not the path to 100% quality, as Dr. Deming explained:

#Deming Gave ex in “Out of the Crisis” of company that proofread docs 11 times but still had lots of customer complaints from errors.

More inspections do not necessarily lead to more quality. Dr. Deming also expresses the idea that having two parallel inspectors might be worse for quality because there’s not clear responsibility, he wrote, “Divided responsibility means no one is responsible.” Yet, the ultimate solution is NOT having just one person doing inspection since that’s not going to be 100% effective, either

#Deming said “A company cannot buy its way into quality” through new machines or technology

Healthcare often relies too much on quality through technology, as well. Technology’s not bad, but quality isn’t as simple as buying something new.

#Deming in Out of the Crisis – if you hire consultant based on low price, “Anyone that engages teaching by hacks deserves to be rooked.”

I wonder how many consulting RFP’s come down to selecting based on price? That’s one reason I don’t like responding to RFP’s. Another Deming thought on that one:

#Deming quoting leader “We cannot afford to purchase [based on] the lowest price. We have to be careful.” – Out of the Crisis

#Deming “Is every job in a job shop done better than the one before?” Asking for “continual improvement” – do we have it in hospitals?

Do we have this in our own job? Are we always doing things better than the day before?

#Deming: “Putting out fires is not improvement of the process.” From Out of the Crisis 1982  http://bit.ly/cUTyBO

It’s hard to improve when you’re always fighting fires. Put out the fire, but then also improve the process to reduce the number of fires in the future.

#Deming (1982) “The greatest waste in America is failure to use the abilities of people.” Still true today? Why?

That tweet got a lot of responses, with people saying that this is still a huge problem. I see this far too often in healthcare, people not being asked to participate in improvement efforts. Management doesn’t want to listen to them.

#Deming: “New knowledge brought into the company might disclose some of our failings.” Need to remove fear so people can embrace new ideas.

Maybe this is one reason managers don’t want to listen to employees – the fear that highlighting problems will make them look like a bad manager. Ironically, not listening to employees and not making improvements makes you a bad manager.

More Deming tweets and thoughts to follow, the rest of Chapter 2. There’s a lot to chew on and to think about. As you read this, is it clear where Dr. Deming influenced Toyota? Do you see any mis-alignment between Deming and Toyota Production System, Toyota Way, or Lean methods or philosophies?


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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

6 Comments on "Re-visiting Chapter 2 of Out of the Crisis (Part 1)"

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  1. Kevin Rutkowski
    Twitter:
    says:

    The Deming statement that “Top mgmt should publish a resolution that no one will lose his job for contribution to quality and productivity,” made me think about a recent story where a nurse in West Texas didn’t just get fired for reporting a problem. She was also charged with a felony! It looks like she was not convicted, though.
    http://www.nytimes.com/2010/02/12/us/12nurses.html

    Still, it seems that anyone will think a little longer before reporting a problem if the hospital will press criminal charges against the reporter.

  2. Mark Graban
    Twitter:
    says:

    Kevin – I’ve had a couple of people contact me about that story in Texas. I’m still researching and will read more over the weekend. On the surface, it sounds horrible and chilling that an indictment would occur (yet alone, a firing). The NY Times story makes it sound like there are two sides to the story, although “she had a vendetta against me” could be completely made up by the MD. I dunno.

    Also troubling to me are cases where nurses have been indicted for their involvement in systemic medical errors. I’ve blogged about this before:

    http://www.leanblog.org/2006/12/just-throw-everyone-in-jail-then/

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