Yes, We Can… but by What Method?


    TRANSCRIPT: Obama's Inaugural Address:

    I guess this is a “mashup” of sorts… between Dr. W. Edwards Deming and President Obama…

    The President said yesterday, in his inauguration speech:

    “We will … wield technology's wonders to raise health care's quality and lower its cost.”

    I absolutely agree that we can do both — improve QUALITY and reduce COST in healthcare. Look at what hospitals like ThedaCare are doing in this regard. Simple things like checklists are reducing surgical errors, which is the right thing to do for the patients and also reduces costs.

    These goals are important. It's critical to realize that there aren't necessarily tradeoffs between cost and quality. By improving processes (in any industry), quality and cost will both improve. Better quality cost less.

    So when faced with goals, Dr. Deming would famously ask “by what method??” It's not enough to have goals.

    President Obama cited “technology.” Technology won't be enough. Electronic Medical Records alone won't help. Technology like robots in the pharmacy might actually improve quality, but at a higher cost.

    The “technology” that we need to remember is Lean. Process improvement methodologies can be considered a technology, right? It's not a silver bullet either, but can we use Lean to help transform healthcare in the United States? Yes, we can.

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    Mark Graban
    Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


    1. I’m a techy guy, and I certainly hope effort and resources are invested in process improvement and not just technology. Great post.

    2. Is there anyone on the inside of Obama’s (excellent but lawyerly) technocracy that gets this?
      I like the way Pascal Dennis said it in the policy deployment class I took from him a few years ago (paraphrasing): There is no shortage of technological ingenuity – car companies use the same robots, same suppliers, etc, but some companies are winning, and others are losing. THe gap is not in technical ingenuity but social ingenuity – how do the PEOPLE involved come together to establish goals, identify and solve problems.
      Obviously some people in the “lean healthcare” community get this. But there is a powerful tendency to go for the capital intensive techno fix in this country (everywhere, probably) and not everyone is going to make it through Imai’s _Gemba Kaizen_.
      So, back to my original question: Is there someone on the inside of the new administration who gets it?

    3. Great question, Andrew. I don’t know about the Obama administration, but I’d be cynical about the hope that there are real process thinkers involved.

      I was equally cynical about that in the W. administration, so this is non-partisan cynicism!

      Paul O’Neill was a process thinker and he didn’t last long as Secretary of the Treasury. We need more men like him in government, I’d say.


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