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.
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.
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.
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.
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…
… Wrong question!
