Revisiting and Re-reading Dr. Deming’s “Out of the Crisis” – Chapter 1


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, 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.

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.

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).

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.

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%).

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.

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:

What do you think? Please scroll down (or click) to post a comment. Or please share the post with your thoughts on LinkedIn – and follow me or connect with me there.

Did you like this post? Make sure you don't miss a post or podcast — Subscribe to get notified about posts via email daily or weekly.

Check out my latest book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation:

Get New Posts Sent To You

Select list(s):
Previous articleA “Go to Gemba” Show (of sorts) Premieres after the Super Bowl
Next articleDr. Atul Gawande and Checklists on “The Daily Show”
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. Some interesting comments on Twitter:

    @Kallokain @LeanBlog People should acknowledge that even if Demmings book has great ideas, it is poorly written. More like scribbled notes

    @smalltalk80 @LeanBlog Then again, some of the most valuable ideas I have encountered are in poorly written books and presentations.

    @smalltalk80 @LeanBlog Prefer to have both great content and form when I can though.

    @Kallokain @LeanBlog The danger is that some arguments are so poorly written that you only understand them if you already “get” lean

    I wrote:
    @smalltalk80 @kallokain Fair enough. Out of the Crisis was the first “lean” book I ever read so it had impact in spite of some bad writing

    @smalltalk80 @kallokain I usually recommend the book about Deming by Rafael Aguayo as a good intro (better writing?).

    That book:

    Chapter 2 of Out of the Crisis is a bit jumbled and doesn’t flow really well. But I think the content and examples in the book are priceless.

  2. I had the good fortune to have a few conversations and exchange some correspondence with Dr. Deming on the application of his system of profound knowledge (described in his book the New Economics). He was always encouraging, but he would get this grin on his face as if he knew the uphill battle involved with transformation of management in healthcare. He had a great article on one of his stays in a hospital (I will try to locate it). One time he told me, “Management will dabble here, and dabble there, but I am not hopeful. There must be a system, and a system must be managed.” I think he would be very encouraged by the work of Thedacare, The Value Leaders Network and LEI.

  3. Mike – are you referring to Dr. Deming’s notes that were published (after his death, I think) in the Deming Institute newsletter? I have a copy of that somewhere or maybe it’s still online. It was his observations from his hospital bed.

  4. As I recall, Deming was one of the few people to embrace the importance of a restored manufacturing capability to the recovery of the Japanese nation and the free world. He was one of the first to offer to them, in a respectful way, a shining path from their situation.

    Right now, we in the US face a situation as dire, in some ways, as the Japanese faced after the second world war and we could surely use some wisdom of Deming, and others, to help show us a shining path, too.

    btw, where Edison failed with the automated voting machine for our government, a little known inventor named Herman Hollerith (sp?) finally did the job. And, his technology provided the seed bed for the company that later became IBM.
    .-= Jefferson Martin ´s last blog ..Integrated Construction Risk =-.


Please enter your comment!
Please enter your name here

This site uses Akismet to reduce spam. Learn how your comment data is processed.