What has really changed these past 15 to 20 years?
After reading Joe De Feo’s July 8, 2011, Quality Digest Daily article, “A Positive Prognosis: Transforming Health Care in America,” I took another look at the wonderful book, Escape Fire (Jossey-Bass, 2003), a compendium of Dr. Donald Berwick’s inspiring plenary speeches at the Institute for Healthcare Improvement’s (IHI) 1992–2002 annual forum. Berwick is probably the leading health care-improvement thinker in the world. He is the former CEO of IHI and, as some of you know, a controversial Obama appointee as head of the Centers for Medicare and Medicaid Administration. In my opinion, he is most definitely the person for the job. As if it wasn’t difficult enough to deal only with health care cultures, he now has the thankless job of integrating messy political agendas into the very serious business of health improvement.
But let’s get back to when all Berwick had to worry about was the current state of health care itself. I’ve extracted three lists that appeared in separate speeches of his and added context from his text. Note that the most recent one is from 1997. It’s all inspiring rhetoric, but truly, what has really changed these past 15 to 20 years? Read more…
As time goes on, I have an increasing affection for the much-neglected run chart
Any article about control charts leads to inevitable (and torturous) discussions of special cause tests—all nine of them. No wonder confused people continue to use things like trend lines. But I’m getting ahead of myself.
First of all, before you take another tools seminar or read another book—except, perhaps, Brian Joiner’s Fourth Generation Management (McGraw-Hill, 1994)—please try Dr. Donald Berwick’s admonition at the end of my Aug. 2, 2011, article, “A New Conversation for Quality Management”: Find something important, and plot it over time. This is probably the best way to learn the most important lesson of quality improvement: That everything is a process, and effective improvement means having new conversations around the crucial distinction between common and special causes. As I have relentlessly tried to make clear, you are swimming in everyday opportunity. Read more…
“I really didn’t say everything I said.” — Yogi Berra
My March 30, 2011 article ended with wisdom from Yogi Berra as a warning to the quality profession. Some prickly reactions to it got me thinking about the last 30 years or so of quality improvement.
The 1980 NBC television show, “If Japan Can, Why Can’t We?” introduced the teachings of W. Edwards Deming to U.S. viewers and caused a quantum leap in awareness of the potential for quality improvement in industry. During the late 1980s, the movement also caught fire in health care. Those of you familiar with Deming’s funnel rules (which shows that a process in control delivers the best results if left alone) will smile to realize that his rule No. 4—making, doing, or basing your next iteration based on the previous one—also known as a “random walk,” has been in operation for the last 30 years. Read more…
Don’t teach people statistics—teach them to solve problems
There are four statements regarding control charts that are myths and in my experience, just refuse to die. The next time you’re sitting in a seminar and someone tries to teach you how to transform data to make them normally distributed, or at any point during the seminar says, “Normal distribution” twice within 30 seconds, leave. You’ve got better things to do with your time.
The four myths
When you attend statistical seminars, do some statistical calculations seem like this? (2 minutes)
Stop getting sucked into the swamp of calculation minutiae
When teaching the I-chart, I’m barely done describing the technique (never mind teaching it) when, as if on cue, someone will ask, “When and how often should I recalculate my limits?” I’m at the point where this triggers an internal “fingernails on the blackboard” reaction. So, I smile and once again say, “It depends.” By the way…