For a number of reasons, I’ve decided to re-read my copy of one of the most influential books I’ve ever read: Out of the Crisis by the late, great Dr. W. Edwards Deming.
In the light of Toyota’s recent quality problems, it’s been suggested by some that Toyota has gotten away from the teachings of Dr. Deming that were so influential in their development of the Toyota Production System after World War II.
What would Deming say? It’s time to dig back into his book. My goal is one chapter a night. I’ll be tweeting some notes as I read (using the hashtag #Deming). Is anyone else going to read along with me?
As I re-read Chapter 1, in <140 character bursts of quotes and thoughts:
- “Folklore has it in America that quality and production are incompatible: that you cannot have both.” – #Deming (tweet)
Folklore, indeed. Just because that idea is so prevalent doesn’t mean that it’s true. We are still fighting that notion in healthcare today. It’s so engrained that better quality means higher costs. That is true if quality means more inspections and more technology. With lean and process improvement methods, better quality leads to lower costs. Hospitals like ThedaCare are proving that quite often now.
- Dr. #Deming, of course, taught that improving quality increases productivity – less wasted effort, happier people, more jobs (tweet)
This all goes hand in hand – cost, quality, and employee happiness (“joy” as Dr. Deming would say). Controversial to some, Dr. Deming certainly thought it was an important purpose of organizations to provide jobs – for the sake of society and our economy.
- Toyota should re-learn #Deming: “Defects and faults that get into the hands of the customer lose the market…” (tweet)
This was certainly true for General Motors. Their famed quality problems let to an irreversible market share decline. Once you have damaged your reputation for quality, it’s very hard to get that back even once you have improved (as GM did and has).
- #Deming wrote the U.S. was the “most underdeveloped nation in the world” because our employees’ knowledge is underused (1982) – still true? (tweet )
What do you think? Is this still true? A few people on Twitter thought so. I’ve heard too many sad variations on “they want us to just do our jobs and not say anything” in healthcare the past few years. So much wasted potential and probably one reason that healthcare costs are so high and quality is so poor.
- #Deming (1982) – 15 to 40% of a manufacturer’s cost is waste. Same is often said of hospitals in 2010, 30 to 40% wasted effort/cost. (tweet )
The same is often said in healthcare – by experts including Donald Berwick, John Toussaint, and Patricia Gabow (MDs, all). The idea being that we can reduce costs by improving quality and productivity, not just by slashing the price paid by the government or insurers (and the government will soon pay >50%).
- #Deming (1982) “Eventually quality improvement will reach not only the production of goods… but the service industries (hospitals )as well” (tweet)
Dr. Deming could see that his methods would eventually be needed outside of manufacturing and industry. Hospitals often know of PDCA/PDSA and Dr. Deming’s name, from earlier training, but there’s often little evidence of his ideas being taken to heart or put into use. His ideas, and the extension of them as “lean” are being used more often in healthcare today, thankfully, for the benefit of patients, hospitals, and staff.
- #Deming “Outputs cannot be considered without considering the goals they are designed to achieve.” Start 1st w/ purpose, then improvement. (tweet)
This sounds like what Jim Womack says through the Lean Enterprise Institute – start first with purpose. Dr. Deming told a story in his book that would have required much more than 140 characters. Thomas Edison invented an automated voting machine for Congress, to instantly tabulate votes. When he presented this to Congress, they were appalled and said it was the last thing they’d want. It turned out that much of the legislative process, the give and take and negotiating, was based on the votes rolling in over a period of time. Edison did not understand this when inventing his machine – without understanding the purpose, it had no use.
I’m most of the way through Chapter 2 now. I’ll continue tweeting and will summarize the tweets and expand on them in occasional blog posts. I’d invite you to do the same via the blog comments.
And a recent video posted by Wiley Publishing with quotes from Dr. Deming:
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