#TBT: My Reflections on Dr. Deming’s Notes from a 1987 Hospital Stay


Today's Post in <50 Words: Today's post points to my guest blog post for the W. Edwards Deming Institute: Reflections on Dr. Deming's Hospital Notes – What Has Changed Since 1990? Why do the same problems that Dr. Deming experienced as a patient 30 years ago still happen so often today?

Today's “Throwback Thursday” is a look at a document written by the late, great W. Edwards Deming back in 1987 after he was hospitalized. You might want to read that first.

In the post, I review Dr. Deming's notes and share some of my reflections and questions about the progress that's been made (or not made) in the 30 years since he wrote that (and in the 12 years since I moved into healthcare).

An excerpt from the post follows…

Listen to this post (and the Deming Institute post) – subscribe

Read Dr. Deming's original article first (PDF):

Excerpt from my post:

The scenarios that Dr. Deming describes in the article could all happen today in a hospital, although he'd likely have a private room and slightly better food. I heard similar complaints from my grandfather before he passed away last year at age 93 (the same age as Dr. Deming when he passed, I just realized). These problems, the same in 1987 or in 2016 include:

  • Nurses get distracted (due to poor systems and work design) and forget to come back to the room, as promised. Care gets delayed.
  • Variation in work methods and practice that are noticeable to patients (and sometimes affect their care).
  • Hospitals run out of medications or supplies due to poor supply chain design (due to choosing the low cost supplier or trying to cut corners on inventory due to a misapplication of “just in time” principles).
  • Nurses can't perform nursing duties (such as giving medications at the right time) because they're busy with tasks that could be done by housekeeping or a “tech.” The same is often true with pharmacists and anesthesiologists. The hospital often thinks they are saving money by skimping on support staff, but that might not really pan out.
  • Little details are often ignored, such as the wash basin or shower design in Dr. Deming's room. A current example might be a hospital not putting a hook for an IV bag in the patient bathroom (a problem often avoided through use of Lean Design methods).
  • Charting often gets done in advance, as a way of saving time, but medications or orders sometimes don't get followed, leading to missed care and inaccurate records.
  • When problems are reported or discovered, the response is too often reactive, with promises to do better and no real improvement.

As Dr. Deming would have said, the problem is not the workers. Hospital leaders need to “learn something about supervision” as only they can “make the changes in procedure and responsibility that are required.”

How much progress has been made? Why do so many of the same problems still exist in too many hospitals?

What would you teach leaders about “supervision” that could lead to better patient care and a better workplace for healthcare providers?


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Mark Graban is an internationally-recognized consultant, author, and professional speaker who has worked in healthcare, manufacturing, and startups. His latest book is Measures of Success: React Less, Lead Better, Improve More. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. He also published the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also a Senior Advisor to the technology company KaiNexus.

  1. Jared Pilbeam says

    I have always found this one of Deming’s musing the most depressing: change to the system requires action by management. If management doesn’t buy in, there’s no real way to improve the system, which can leave one in a futile state of powerlessness(unless you’re a manager). I have spent years trying to figure a way around this, trying to figure out if there’s a way for the people working on the manufacturing lines (or in this case, the nurses and aides) to overcome this hurdle, but there’s just no way. Typically, as soon as management gets wind of any “improvements” made without them in the loop, they shut it down.

    Are there any good ways to influence management to at least educate themselves a little bit on what true lean actually is? I’ve tried showing them Deming’s works, his fourteen points, etc., but it just goes ignored. Instead, all too many times, I’ve experienced the blame game, and “being held accountable”, no matter how thoroughly I explain how the system could be improved to preclude issues that rob value from the customer, and joy from my work.

    1. Mark Graban says

      Thanks for the comment.

      It might be depressing, but I think it’s true: upper management owns “the system” so they are responsible for changing it.

      Individual employees can, of course, initiate Kaizen improvements that fix something locally. But, Dr. Deming would have warned that “everybody’s best efforts” to improve might be sorta useless of management doesn’t fix aspects of the system that drive waste (like focusing too much on cost cutting, choosing the wrong suppliers, etc.).

      It’s a shame when management not only doesn’t fix the system, but shuts down people who are trying to make local improvement.

      I’m sorry to be cynical about it, but Deming and the “quality movement” were somewhat popular in the 1980s. I think sometimes that the movement died with him in 1993. I don’t see many businesses or organizations that are focused on quality these days. I think “being cheap” won out.

      1. Jared Pilbeam says

        Well, at least we have people like you and the other writers here and online still trying to keep Deming’s Principles alive. Thank you for teaching me a little something new every day.

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